肝移植治疗原发性肝.ppt

手术方式对预后的影响FisheraRA,KulikbLM,FreisecCE,etal.Hepatocellularcarcinomarecurrenceanddeathfollowinglivinganddeceaseddonorlivertransplantation.AmericanJournalofTransplantation2007;7:1601–1608.手术方式对预后的影响LiC,WenTF,YanLN,etal.Outcomeofhepatocellularcarcinomatreatedbylivertransplantation:comparisonoflivingdonoranddeceaseddonortransplantation.HepatobiliaryPancreatDisInt，2010,9:366-369.手术方式对预后的影响VakiliK,PomposelliJJ,CheahYL,etal.LivingDonorLiverTransplantationforHepatocellularCarcinoma:IncreasedRecurrencebutImprovedSurvival..Livertransplantation,2009,15:1861-1866.手术方式对预后的影响HwangS,LeeSG,AhnCS,etal.Small-sizedlivergraftdoesnotincreasetheriskofhepatocellularcarcinomarecurrenceafterlivingdonorlivertransplantation.TransplantationProceedings,2007,39:1526–1529.理论上讲，小体积移植物的缺血再灌注损伤和肝再生导致的血管生成可能促进肿瘤进展01但目前临床实际影响并不明确02目前临床证据表明，移植物类型对肝移植术后肿瘤进展并无或仅有轻微影响03手术方式对预后的影响等待时间对预后的影响ChaoSD,RobertsJP,FarrM,etal.Shortwaitlisttimedoesnotadverselyimpactoutcomefollowinglivertransplantationforhepatocellularcarcinoma.AmericanJournalofTransplantation2007;7:1594–1600.肝癌肝移植术后肿瘤

复发的预防控制肿瘤生长和血管侵润新辅助治疗减少患者移植术后复发风险肿瘤降期，使移植成为可能术前治疗的目的术前治疗术前治疗—TACENoconvincingargumentsshowingthatTACEreducestherateofdropoutbeforeLTNoconvincingargumentsshowingthatTACEimprovesthesurvivalafterLTAlthoughTACEinducedcompletetumornecrosisinsomepatientsBelghitiJ,CarrBI,GreigPD,etal.TreatmentbeforeLiverTransplantationforHCC.AnnalsofSurgicalOncology,2008,15:993–1000.术前治疗—TACEDownstagingofHCCbyTACEispossibleinone-thirdtoone-halfofLTcandidatesButthesepatientshavehigherdropoutrates,higherrecurrenceratesThereisnosufficientevidencethatpretransplantTACEmaydelineatethepossibilityofexpandingcurrentselectioncriteriaforOLTinpatientswithHCCBelghitiJ,CarrBI,GreigPD,etal.TreatmentbeforeL