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目的总结肝移植治疗肝细胞癌合并胆管癌栓的临床经验。方法回顾性分析2003年10月至2012年12月期间于笔者所在医院接受肝移植治疗的3例肝细胞癌合并胆管癌栓患者的临床资料,总结临床经验。结果3例肝细胞癌合并胆管癌栓患者均行改良背驮式原位肝移植术。术后免疫抑制剂方案均采用他克莫司+吗替麦考酚酯+甲泼尼龙。术后2例行全身化疗。2例口服拉米夫定抗病毒治疗,1例口服恩替卡韦抗病毒治疗。3例患者均联合应用乙型肝炎免疫球蛋白预防乙肝复发。术后2例分别无瘤生存141个月和38个月,1例于术后3年死于肿瘤复发。结论对于肝细胞癌合并胆管癌栓患者,选择适当病例施行肝移植手术,可能是一种积极有效的治疗措施。
Objective To summarize the clinical experience of liver transplantation in the treatment of hepatocellular carcinoma complicated by cholangiocarcinoma. Methods The clinical data of 3 patients with hepatocellular carcinoma complicated with cholangiocarcinoma thrombus admitted to our hospital from October 2003 to December 2012 were analyzed retrospectively to summarize the clinical experience. Results Three cases of hepatocellular carcinoma with cholangiocarcinoma were treated with modified piggyback orthotopic liver transplantation. Postoperative immunosuppressive regimens were used tacrolimus + mycophenolate mofetil + methylprednisolone. After 2 cases of systemic chemotherapy. 2 cases of oral lamivudine antiviral therapy, 1 case of oral entecavir antiviral therapy. 3 patients were combined with hepatitis B immunoglobulin to prevent hepatitis B recurrence. Two patients survived 141 months and 38 months respectively after operation. One patient died of tumor recurrence 3 years after operation. Conclusion For patients with hepatocellular carcinoma complicated by cholangiocarcinoma, selecting appropriate cases for liver transplantation may be a positive and effective treatment.