【摘要】 目的比较肝癌肝移植术后肝内复发的患者分别实施肿瘤切除术、经导管肝动脉灌注化疗栓塞术(TACE)、射频消融术(RFA)、再次原位肝移植术(re-OLT)的临床疗效。方法回顾性分析我中心2004年1月至2009年6月因肝癌行肝移植手术术后肝内复发的患者53例。其中肿瘤切除术3例,TACE22例,RFA18例,re-OLT10例,观察术前一般情况、术后生存时间、术后并发症、肿瘤进展情况、治疗费用等情况。重点对比分析TACE、RFA、re-OLT三种治疗方法的疗效。结果肿瘤切除术3例,随访4～12个月,均无手术并发症,未见肝脏及远处复发或转移,一般情况良好。TACE组、RFA组与re-OLT组的平均生存时间、累积生存率、各部位进展情况的差异无统计学意义;RFA组的并发症,特别是胆道并发症发生率比TACE组及re-OLT组低;3组的治疗费用的差异有统计学意义,RFA<TACE<re-OLT。结论 TACE、RFA及re-OLT治疗方法对肝癌肝移植术后肝内复发的治疗效果相近。RFA的并发症及治疗费用明显少于TACE及re-OLT,可作为肝癌肝移植术后肝内复发的首选治疗方案。更多还原

【Abstract】 Objective To investigate pre-treatment condition,mean survival time,survival rate,tumor progression condition,complications and treatment cost of transcatheter arterial chemoembolization(TACE),radiofrequency ablation(RFA) and orthotopic liver retransplantation(re-OLT).Methods Retrospective analysis of 53 cases reported for intrahepatic recurrence after liver transplantation of our hospital,from Jan.2004 to Jun.2009.There were 3 patients received surgical resection,22 for TACE,18 for RFA and 10 for re-OLT.The pre-treatment condition,survival time,tumor progression condition,complications and treatment cost of the patients of surgical resection are investigated.Treatment effect of the patients received TACE,RFA and re-OLT were compared and analyzed.Results Three patients received surgical resection.After 4-12 months follow-up,they had not been found complications and tumor progression,and they were still alive.The difference of mean survival time,survival rates and the tumor progression condition among TACE,RFA and re-OLT are considered no significant;But RFA was lower in severe degree of complication,especially the biliary complications,and the cost of treatment:RFA<TACE<re-OLT.Conclusions The curative effect among TACE,RFA and re-OLT are similar to one other in curing the tumor recurrence of liver cancer after liver transplantation.RFA is much lower than TACE and re-OLT in severe degree of complication and the cost of treatment.更多还原