肾移植后肝脏新发肿瘤的临床治疗及预后
Clinical treatment and prognosis of de novo liver cancer following renal transplantation
张雅敏 1刘子荣 1崔子林 1李阳 1王连江 1王建 1沈中阳1
作者信息
- 1. 300192 天津市第一中心医院肝胆外科
- 折叠
摘要
目的 探讨肾移植后肝脏新发肿瘤患者的临床治疗及预后.方法 回顾性分析2011年6月至2016年6月天津市第一中心医院收治的15例肾移植术后肝脏新发肿瘤患者的临床资料.15例肝脏新发肿瘤的确诊时间为肾移植术后23～98个月,平均(42.5±29.7)个月.其中肾移植术后2年内发病2例,5年内发病7例,5年后发病6例.结果 15例患者中,3例行TACE治疗;其余12例接受手术切除,其中右或左半肝切除5例,肝段切除4例,局部肿瘤剜除3例.术后病理证实肝细胞癌8例,胆管细胞癌1例,混合性肝癌3例.有12例患者首选根治性手术切除,其中3例分别于术后8、16、25个月死于肿瘤复发,另9例术后随访0.6 ～65.0个月仍存活.首选TACE治疗的3例患者,分别存活4、7和13个月.结论 肾移植术后新发肝癌患者发病隐匿、进展迅速,早期诊断、积极治疗、优化免疫抑制方案、保护移植肾功能是提高长期生存的关键措施.
Abstract
Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.
关键词
肾移植/肝癌/肝切除术/肝动脉化疗栓塞/免疫抑制剂Key words
Renal transplantation/Liver carcinoma/Hepatectomy/Transcatheter arterial Chemoembolization (TACE)/Immunosuppressant引用本文复制引用
基金项目
国家自然科学基金(81370576)
天津市应用基础与前沿技术研究计划(14JCYBJC24800)
出版年
2017
NETL
NSTL
维普
万方数据