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《肝癌切除術(shù)后復(fù)發(fā)患者行肝移植后移植肝再發(fā)肝癌的治療對策》由會員上傳分享,免費在線閱讀,更多相關(guān)內(nèi)容在行業(yè)資料-天天文庫。
1、肝癌切除術(shù)后復(fù)發(fā)患者行肝移植后移植肝再發(fā)肝癌的治療對策--1例長期存活病例報道并相關(guān)文獻(xiàn)復(fù)習(xí)發(fā)表者:徐新保(訪問人次:982)摘要:目的 總結(jié)原發(fā)性肝癌切除術(shù)后復(fù)發(fā)患者行肝移植后新肝再發(fā)肝癌的治療經(jīng)驗。方法 2003年11月14日空軍總醫(yī)院肝膽外科為1例肝癌切除術(shù)后復(fù)發(fā)患者施行了同種異體原位肝移植。肝移植術(shù)后(以下簡稱術(shù)后)3個月時曾返院化療。術(shù)后19個月時發(fā)現(xiàn)移植肝首次出現(xiàn)肝癌復(fù)發(fā),隨后依次施行經(jīng)皮肝穿刺射頻消融、肝動脈化療栓塞、術(shù)中射頻消融及肝左內(nèi)葉腫瘤切除術(shù)等序貫綜合治療。術(shù)后31個月時發(fā)現(xiàn)移植肝再次復(fù)發(fā)肝癌,依次給予經(jīng)肝動脈化
2、療栓塞、術(shù)中肝右前葉腫瘤射頻治療及肝右后葉腫瘤切除等綜合治療。術(shù)后5年時發(fā)現(xiàn)門靜脈血栓,出現(xiàn)肝功能異常,經(jīng)保肝、抗凝、補充白蛋白等治療后肝功能逐漸恢復(fù)?;颊吒我浦矅中g(shù)期及術(shù)后接受常規(guī)抗乙肝病毒治療。術(shù)后常規(guī)服用抗排異藥物。結(jié)果 該患者肝移植手術(shù)及術(shù)后恢復(fù)較為順利。肝移植術(shù)后2次肝癌復(fù)發(fā)均成功治愈,第2次復(fù)發(fā)治愈后無腫瘤復(fù)發(fā)。乙肝病毒脫氧核糖核酸定量均小于103copies/ml,患者至今仍然健康生存,肝功能基本正常。結(jié)論 對原發(fā)性肝癌切除術(shù)后肝癌復(fù)發(fā)的病例,只要復(fù)發(fā)肝癌符合中國杭州標(biāo)準(zhǔn),仍應(yīng)積極進行肝移植。對于肝移植術(shù)后新肝復(fù)發(fā)肝癌
3、的患者,積極的序貫綜合治療及手術(shù)切除仍可能獲得治愈??哲娍傖t(yī)院肝膽外科徐新保關(guān)鍵詞:原發(fā)性肝癌;切除;復(fù)發(fā);肝移植Livertransplantationforrecurrenceofprimarylivercarcinomaafterresectionandtherapyofrecurrenthepatocellularcarcinomaatthelivergraft(along-termsurvivingcasereportandrelatedliteraturereview).Abstract:ObjectiveOutlinet
4、heexperienceof1caseoflivertransplantationforrecurrenceofprimarylivercarcinomaafterresectionandthetherapeuticmeasuresforrecurrentprimarylivercarcinomaofthenewlytransplantedliver.Methods Onepatientunderwentlivertransplantationbecauseofrecurrenceoflivercarcinomaafterresect
5、ioninAirforcegeneralhospitalofChinesePLAonNovember14,2003.Thepatientacceptedvenouschemotherapy3monthslater.19monthsafterlivertransplantation,recurrentprimarylivercarcinomawasfoundinthetransplantedliver,andthenthesequentialtherapyofradiofrequencyablation,hepaticarteryche
6、motherapyandembolization,introperativeradiofrequencyablationandtumorectomywereperformedrespectively.31monthsafterlivertransplantation,recurrentprimarylivercarcinomawasagainfoundinthetransplantedliver,andthenthesequentialtherapyofhepaticarterychemotherapyandembolization,
7、introperativeradiofrequencyablationandtumorectomywereperformedalsorespectively.5yearslaterafterlivertransplantation,dysfunctionofliveremergedduetoportalveinthrombus,thenthepatientunderwenthepatoprotection,anticoagulation,supplementofalbuminandothertreatments,andgraduall
8、ygainedrestorationofliverfunction.Anti-HBVtherapywasgiventothepatientduringperioperativeandpostoperativeperiod