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目的探讨难治性复发肝肿瘤行肝移植的难点及围手术期处理注意事项。方法总结2003年9月至2004年9月我科施行的14例肝移植,其中难治性复发肝肿瘤9例(A组),其余5例术前未接受任何有创治疗(B组),分析两组术前治疗情况、术中探查情况、病肝游离时间、无肝期时间、术中出血、输血及止血药物使用情况、手术死亡率、术后肾上腺糖皮质激素的减撤及化疗等情况。结果A组术中病肝游离时间、无肝期时间明显较B组长,出血、输血量及止血药物的用量均明显大于B组,手术死亡2例均为A组病例。术后存活的肝癌病例均行全身化疗,肾上腺糖皮质激素于3个月内停药,至今均无瘤生存。结论难治性复发肝肿瘤的肝移植较一般肝移植手术难度大,对术者要求更高,术中监护和补充凝血因子极为重要。围手术期抗肿瘤治疗、术后尽早减撤肾上腺糖皮质激素对术后无瘤生存有积极意义。
Objective To investigate the difficulties of liver transplantation in refractory recurrent liver tumor and precautions of perioperative management. Methods From September 2003 to September 2004, 14 cases of liver transplantation underwent in our department, including 9 refractory recurrent liver tumors (group A) and the remaining 5 patients without any invasive treatment before surgery (group B) Analysis of two groups of preoperative treatment, intraoperative exploration, liver disease free time, anhepatic time, intraoperative bleeding, blood transfusion and hemostatic drug use, operative mortality, postoperative adrenal corticosteroid withdrawal and chemotherapy Happening. Results A group of intraoperative liver free time, anhepatic period was significantly longer than the B group, bleeding, transfusion volume and the amount of hemostatic drugs were significantly greater than the B group, 2 cases of surgical death were A group of cases. Postoperative liver cancer patients underwent systemic chemotherapy, adrenal glucocorticoid withdrawal within 3 months, so far no tumor-free survival. Conclusion Liver transplantation in patients with refractory recurrent liver tumor is more difficult than that in general liver transplantation. It requires more surgery, and intraoperative monitoring and supplementation of clotting factors are extremely important. Perioperative antitumor therapy, as soon as possible postoperative withdrawal of glucocorticoid on postoperative tumor-free survival have a positive meaning.