摘要
目的探讨肝硬化失代偿期并发意外肝癌患者的肝移植效果及其临床特点。方法11例肝硬化失代偿期患者接受原位肝移植，在术后的病肝病理检查中意外发现癌灶（称之为“意外肝癌”），其原发病，8例为乙型肝炎后肝硬化，丙型肝炎后肝硬化、酒精性肝硬化和原发性硬化性胆管炎各1例；11例术后采用他克莫司、霉酚酸酯及甲泼尼龙预防排斥反应，3个月后撤除霉酚酸酯，6个月后撤除甲泼尼龙。病肝沿水平面作间隔1cm连续平行切片，对于直径大于1cm或有灰白色结节者，完整取材。结果11例中，术前仅4例（36．4％，4／11）的甲胎蛋白（AFP）水平超过正常值。除1例肿瘤为多发外，其余均为单发，肿瘤直径最大为2．0cm，平均直径为1．18cm；肿瘤TNM分期，Ⅰ期占72．7％，Ⅲ期占27．3％；存在微血管侵犯2例，包膜完整、无血管及淋巴侵犯2例；病理诊断为胆管细胞癌1例，肝细胞癌10例。术后随访12～50个月，1例因肿瘤复发于术后10个月死亡。结论意外肝癌的病理学特点为肿瘤分期早，多为单发，组织分化程度高，肝移植后的1年存活率与良性肝病患者肝移植类似，肿瘤复发率低。
Objective To investigate the clinical characteristics and results of liver transplantation for end stage of liver cirrhosis with incidental liver neoplasm. Methods Incidental findings of liver neoplasm were found by pathological examination of cirrhotic liver explant. The primary diseases included cirrhosis following hepatitis B （8 cases）, cirrhosis following hepatitis C （ 1 case）, alcoholic cirrhosis （1 case）, and primary sclerosing cholangitis （1 case）. Immunosuppressive agents included tacrolimus, mycophenolate, and prednisolone after liver transplantation. Mycophenolate mofetil was withdrawn 3 months later, and prednisolone withdrawn 6 months later. The cirrhotic liver explant was serially sectioned in the intervals of 1 cm, and the gray nodes with diameter more than 1 cm were completely removed. Results In the 11 cases, serum AFP level in 4 cases was abnormal （36. 4%）. There was one case of multiple tumor and 10 cases of solitary tumor （mean diameter 1.18 cm and maximum diameter 2. 0 cm）. There were 72. 7% patients having TNM Ⅰ stage and 27. 3% TNM Ⅲ stage. Microvascular invasion occurred in 2 cases, and there were 2 cases without capsule breakdown and microvascular or lymph invasion. Pathologically, one case was diagnosed as cholangiocellular carcinoma and 10 cases as hepatocellular carcinoma. During the follow-up of 12-50 months, one case died of recurrence 10 months after transplantation. Conclusion Characteristics of incidental liver neoplasm was solitary and high differentiation, the one-year survival rate was similar to end stage of liver cirrhosis, and the ratio of recurrence was low.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2007年第1期28-30,共3页
Chinese Journal of Organ Transplantation
关键词
肝移植
肝肿瘤
偶然发现
肝硬化
Liver transplantation
Liver neoplasms
Incidental findings
Liver cirrhosis
