摘要
随着围手术期病人的选择和管理的进步,肝移植已经成为公认的治疗肝胆恶性肿瘤的重要手段之一。原发性肝细胞肝癌作为肝移植的主要适应症,在一些器官移植中心占肝移植病例总数已经达到20%～40%,远期预后与良性肝病相似。但是肝移植治疗在其他原发性或继发性肝恶性肿瘤报道较少。近期有报道显示,肝移植在治疗高位肝门部胆管癌中疗效显著,在治疗肝上皮样血管内皮瘤中多可获得良好的长期生存,与之相比较,肝脏恶性血管皮内细胞瘤疗效则差强人意,目前尚无长期存活报道;肝母细胞瘤是儿童期最常见的肝恶性肿瘤,对化疗高度敏感,有报道称对于无法切除的肝母细胞瘤的肝移植疗效也是令人鼓舞的;对于神经内分泌瘤肝转移的手术适应症主要为无法切除的功能性类癌伴低表达肿瘤活性因子-ki67,以及姑息治疗无法控制临床症状者;对于结肠癌肝转移患者,虽然近期有报道显示术后生存时间较先前有所提高,但由于结肠癌肝转移患者术后肿瘤的高复发率使肝移植治疗颇存争议。
Liver transplantation （LT） has become an accepted therapy for selected patients with hepatobiliary malignancies, although the evolution of this acceptance has hinged upon improvements in selection and management of these patients before and after LT. Hepatocellular carcinoma as an indication for LT accounts for up to 20% ～ 40% of cases at some centers and the outcomes are similar to some non-malignant indications.The experience of using LT for other primary and secondary malignancies of the liver is much smaller. Recent outcomes of LT for a highly select group of patients with hilar cholangiocarcinoma appears promising. Excel- lent survival has also been reported for patients with unresectable hepatic epithelioid hemangioendothelioma （HEHE）, in distinct contrast to the results of LT for angiosarcoma, in which no long-term survivors have been reported. Hepatoblastoma （HB） is the most common primary liver cancer in pediatric age group and long-term outcomes after LT in patients with unresectable HB and demonstrating good response to chemotherapy are also encouraging. The indications for LT in patients with hepatic metastasis from neuroendocrine tumors （NET） are mainly in patients with unresectable functional carcinoid tumors with low tumor activity index （Ki67） with good survival and providing palliation of medically uncontrollable symptoms. More controversial, are the recent outcomes on the utility of LT for unresectable hepatic metastases from colorectal cancer, which have demonstrated increased survival compared to the previous reports, however, because of a high rate of tumor recurrence, this indication has yet to be adopted by the transplant community.
出处
《兰州大学学报（医学版）》
CAS
2015年第6期1-11,共11页
Journal of Lanzhou University（Medical Sciences）
关键词
肝脏移植
肝细胞肝癌
纤维板层型肝细胞癌
胆管癌
肝上皮样血管内皮瘤
肝母细胞癌
肉瘤
神经内分泌肿瘤
结直肠癌
liver transplantation
hepatocellular carcinoma
fibrolamellar hepatocellular carcinoma
cholan- giocarcinoma
hepatic epithelioid hemangioendothelioma
hepatoblastoma
sarcoma
neuroendocrine tumor
colorectal cancer
