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目的探讨超出米兰标准的原发性肝癌肝移植术后化疗对患者存活时间及肿瘤复发率的影响。方法2002年7月至2004年12月间对46例超出米兰标准的原发性肝癌患者行原位肝移植,其中44例患者接受术后化疗,分析术后化疗患者的临床资料,观察化疗后的不良反应,统计患者肝移植术后的存活率及肿瘤复发率,比较术前是否存在癌栓以及术后是否化疗对存活率和肿瘤复发率的影响。结果44例患者在化疗过程中均出现不同程度的胃肠道反应;16例患者出现肝功能损害,经停药、调整免疫抑制剂用量及使用护肝药后恢复;7例患者出现白细胞减少,采用粒细胞集落刺激因子类药物治疗后恢复正常。肝移植术后化疗的患者存活超过1年的有22例,1年存活率为47.8%,最长存活至今已有30个月。26例患者在1年内肿瘤复发,1年复发率为59.1%。术前有癌栓的患者术后肿瘤复发率明显高于无癌栓的患者,存活率明显低于无癌栓的患者。肝移植术后化疗的患者与术后未化疗的患者相比,存活率升高,肿瘤复发率降低。结论超出米兰标准的原发性肝癌患者肝移植术后化疗可提高生存率,减少肿瘤复发的可能。肝移植术后辅助性化疗是安全、可行的,且患者可以耐受。
Objective To investigate the effect of chemotherapy after liver transplantation that exceeds the Milan criteria on survival time and tumor recurrence rate in patients with liver cancer. Methods From July 2002 to December 2004, 46 patients with primary liver cancer beyond Milan criteria were treated with orthotopic liver transplantation. Among them, 44 patients received postoperative chemotherapy and analyzed the clinical data of postoperative chemotherapy patients. After chemotherapy The survival rate and tumor recurrence rate after liver transplantation were statistically analyzed. The presence of tumor thrombus and the effect of postoperative chemotherapy on the survival rate and tumor recurrence rate were compared. Results All the 44 patients showed different degrees of gastrointestinal reactions during chemotherapy. Sixteen patients had liver dysfunction. After discontinuation of treatment, the dosage of immunosuppressant and the recovery of hepatoprotective drugs were restored. Seven patients had leukopenia, After using granulocyte colony stimulating factor drugs returned to normal. Twenty-two patients survived more than one year after liver transplantation and had a one-year survival rate of 47.8%. The longest survival period has been 30 months. Tumor recurrence occurred in 26 patients within one year, with a one-year recurrence rate of 59.1%. Postoperative tumor recurrence rate was significantly higher in patients with tumor thrombus than in patients without tumor thrombus, the survival rate was significantly lower than those without tumor thrombus. Compared with patients who did not receive chemotherapy after liver transplantation, the survival rate increased and the tumor recurrence rate decreased. Conclusions Chemotherapy after liver transplantation in patients with primary liver cancer exceeding the Milan standard can improve the survival rate and reduce the possibility of tumor recurrence. Adjuvant chemotherapy after liver transplantation is safe and feasible, and the patient can tolerate it.