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肝细胞癌的肝脏移植治疗

Authors
George Tsoulfas, MD
Steven A Curley, MD, FACS
Eddie K Abdalla, MD
Carlton C Barnett, Jr, MD
Martin Hertl, MD
Section Editors
Kenneth K Tanabe, MD
Robert S Brown, Jr, MD, MPH
Deputy Editor
Diane MF Savarese, MD
Translators
吕国悦, 主任医师，教授

引言

肝细胞癌(hepatocellular carcinoma, HCC)是一种侵袭性肿瘤，在慢性肝病和肝硬化的情况下经常发生。 (参见“肝细胞癌的流行病学和病因学关联”)

唯一可能的治愈性治疗方式是肝脏切除和肝脏移植。在不适合进行肝脏切除的患者中，某些有肝硬化和HCC的患者适合行有治愈性可能的肝脏移植。不幸的是，大多数患者都因肿瘤侵犯范围过大、存在潜在肝功能障碍及缺乏供体器官而不符合肝脏切除或肝脏移植的条件。这使得许多其他的HCC治疗方式和联合疗法得以出现，其中包括局部肿瘤消融术。 (参见“潜在可切除性肝细胞癌的手术治疗”)

HCC的治疗流程 — 目前有几种局限性HCC的治疗方法。一般治疗方法如图所示(诊断流程 1)。巴塞罗那研究小组也已发布了另一种可供选择的治疗流程(诊断流程 2)[1]。

然而，由于新的治疗方式及各种治疗方法的适应证正处于迅速发展之中，所以尝试生成HCC治疗方法的流程很困难。此外，治疗方式往往会因可用专业技术的不同而不同。这些问题及HCC的一般治疗方法将在别处详细讨论。 (参见“肝细胞癌治疗方法的概述”)

HCC肝脏移植的演变

肝脏移植治疗HCC是一种比较吸引人的方法，因为在切除恶性肿瘤的同时还可替换仍处于新发病变风险的硬化的肝脏。但是，对于有不可切除的局限性HCC的患者而言，早期的肝移植的经验令人十分失望。90日死亡率高到另人无法接受、出现肿瘤复发的患者多达80%以及远期生存率远低于因非恶性病变行肝脏移植的患者，以上所有情况均反映了该病的进展期性质[2,3]。

                             

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-27.
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