原位肝移植治疗肝门部胆管癌二例报告
Orthotopic liver transplantation for the treatment of klatskin tumor
目的 探讨肝门部胆管癌是否为肝移植的适应证.方法 为2例肝门部胆管癌的患者施行了同种原位肝移植术.供肝切取采用腹腔器官联合快速切取法,灌洗液及保存液为UW液.无肝期采用Bio-Medicus转流泵行体外静脉转流.术后免疫抑制治疗,例1采用环孢素A、泼尼松和硫唑嘌呤三联用药,例2采用霉酚酸酯代替硫唑嘌呤.结果 移植后肝功能恢复正常,黄疸减退,但例1术后4天因血液浓缩而出现脑栓塞,肺内感染,术后12天死于多器官功能衰竭;例2移植后4周顺利出院,但5个月后死于肿瘤复发.结论 肝门部胆管癌Bismuth Ⅳ型仍不失为肝移植的适应证,但术前判定是否有微转移灶及术前、术中与术后有效的辅助治疗、防止肿瘤复发等是需要解决的重要课题.
更多Objective To investigate whether or not that klatskin tumor is adapt to liver transplantation. Methods In April 1995 and Nov. 1997, orthotopic liver transplantation was successfully performed on 2 cases of klatskin tumor. The liver graft was harvested by combined rapid multiple organ harvesting technique, flushed and preserved with UW solution. Veno-venous bypass was processed with Bio Medicus pump in anhepatic phase. Immunosuppressive protocol was cyclosporin A, prednisone and azathio prine, while azathioprine was replaced by cellcept in case 2. Results Liver function recovered rapidly with an obvious regression of jaundice. Hemoconcentration occurred in case one on the 4 th postoperative day, followed by cerebral thrombosis and lung infection, and died of multiple system organ failure on the 12 th postoperative day. Another one was discharged 4 weeks postoperation, but died of tumor recurrence after 5 months. Conclusion The Bismuth IV hilar bile duct cancer is adapt to liver transplantation. But how to assess whether or not there are micro-metastases before operation and effectively control tumor recurrence postoperation are important projections needed to resolve.
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