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目的总结原发性肝癌切除术后复发患者行肝移植后新肝再发肝癌的治疗经验。方法 2003年11月14日空军总医院肝胆外科为1例肝癌切除术后复发患者施行了同种异体原位肝移植。肝移植术后(以下简称术后)3个月时曾返院化疗。术后19个月时发现移植肝首次出现肝癌复发,随后依次施行经皮肝穿刺射频消融、肝动脉化疗栓塞、术中射频消融及肝左内叶肿瘤切除术等序贯综合治疗。术后32个月时发现移植肝再次复发肝癌,依次给予经肝动脉化疗栓塞、术中肝右前叶肿瘤射频治疗及肝右后叶肿瘤切除等综合治疗。术后5年时发现门静脉血栓,出现肝功能异常,经保肝、抗凝、补充白蛋白等治疗后肝功能逐渐恢复。患者肝移植围手术期及术后接受常规抗乙肝病毒治疗。术后常规服用抗排异药物。结果该患者肝移植手术及术后恢复较为顺利。肝移植术后2次肝癌复发均成功治愈,第2次复发治愈后无肿瘤复发。乙肝病毒脱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。结论对原发性肝癌切除术后肝癌复发的病例,只要复发肝癌符合中国杭州标准,仍应积极进行肝移植。对于肝移植术后新肝复发肝癌的患者,积极的序贯综合治疗及手术切除仍可能获得治愈。
Objective To summarize the experience in the treatment of recurrent liver cancer after liver transplantation in patients with recurrent hepatocellular carcinoma. Methods On November 14, 2003, the Department of Hepatobiliary Surgery of the General Hospital of the Air Force performed an allogeneic orthotopic liver transplantation in 1 patient with recurrence after hepatectomy. Liver transplantation (hereinafter referred to as postoperative) was returned to hospital for chemotherapy at 3 months. At the 19th month postoperatively, liver cancer recurred for the first time in the transplanted liver, followed by sequential comprehensive treatment such as percutaneous radiofrequency ablation, hepatic arterial chemoembolization, intraoperative radiofrequency ablation, and hepatic left lobe tumor resection. At 32 months after the operation, the transplanted liver was found to have recurrence of hepatocellular carcinoma, followed by hepatic arterial chemoembolization, intraoperative radiofrequency ablation of the right anterior lobe tumor, and resection of the right posterior lobe tumor. Portal vein thrombosis was found at 5 years after operation and abnormal liver function was observed. Liver function was gradually restored after hepatoprotection, anticoagulation, and albumin supplementation. Perioperative liver transplantation received routine anti-hepatitis B virus treatment during and after surgery. After routinely taking anti-rejection drugs. Results The patient’s liver transplant operation and postoperative recovery were relatively smooth. Hepatoma recurrence was successfully cured after liver transplantation, and no tumor recurrence was observed after the second relapse. The quantification of DNA of hepatitis B virus is less than 103 copies/ml. The patient is still healthy and has normal liver function. Conclusions Liver cancer recurrence after primary liver cancer resection should be performed actively as long as the recurrence liver cancer meets the Chinese Hangzhou standard. For patients with new liver recurrence liver cancer after liver transplantation, active sequential synthetic treatment and surgical resection may still be cured.