Successful Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization followed by Radical Liver Transplantation in a Patient with Severe Liver Damage
Successful Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization followed by Radical Liver Transplantation in a Patient with Severe Liver Damage
复制标题
经导管动脉化疗栓塞继之以根治性肝移植成功治疗严重肝损伤患者的肝细胞癌
DOI：
10.1159/000499703
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发表时间：
2019
影响因子：
0.8
通讯作者：
Kato Junji
中科院分区：
文献类型：
--
作者：
Nakamura Hajime;Kawano Yutaka;Miyanishi Koji;Ishikawa Kazuma;Kubo Tomohiro;Tanaka Shingo;Takada Kohichi;Kobune Masayoshi;Harada Kohei;Kawamura Norio;Shimamura Tsuyoshi;Kanno-Okada Hiromi;Kato Junji
前言肝细胞癌的肝移植是治疗潜在肝病和癌症的一种有效方法。然而，对于米兰标准以外的肝细胞癌患者，肝移植的作用仍然存在争议。病例介绍一名50多岁的男子被诊断为有两个肝细胞癌和晚期肝硬变，被转至本院进行进一步检查和治疗。两个病灶均位于肝8段，直径分别为39 mm和9 mm。内窥镜检查显示，食道静脉曲张出血的风险很高。在内窥镜下结扎食道静脉曲张后，他接受了经导管动脉化疗栓塞术(TACE)以降低晚期肝癌的分期。TACE后没有观察到进一步的肝脏恶化，并且肝细胞癌的分期被成功地降低到米兰标准之内。TACE后110天，他接受了肝移植；在移植后2.5年，他仍然活着，没有肝细胞癌复发。讨论/结论对于晚期肝细胞癌合并严重肝损害的患者，只有少数治疗方案可供选择。多学科治疗，如局部治疗和预防静脉曲张出血，可能会导致肿瘤降期，使根治性肝移植能够在不进一步加重肝脏损害的情况下实现。
IntroductionLiver transplantation for hepatocellular carcinoma (HCC) has been established as a curative therapy of underlying liver disease and cancer. However, the role of liver transplantation remains controversial for patients with HCC beyond Milan criteria.Case PresentationA man in his 50s who was diagnosed as having two foci of HCC and advanced liver cirrhosis was referred to our hospital for further examination and treatment. Both foci of HCC were located in segment 8 of the liver and measured 39 and 9 mm. Endoscopy showed esophageal varices that had a high risk of bleeding. After endoscopic ligation of the esophageal varices, he underwent transcatheter arterial chemoembolization (TACE) for downstaging of the advanced HCCs. No further liver deterioration was observed after TACE, and HCC staging was successfully downstaged to within the Milan criteria. One hundred ten days after TACE, he underwent liver transplantation; at 2.5 years after transplantation, he remains alive without HCC recurrence.Discussion/ConclusionThere are only a few treatment options available for patients with advanced HCC and severe liver damage. Multidisciplinary treatment such as locoregional treatments and prophylaxis of variceal bleeding may result in tumor downstaging, enabling radical liver transplantation without further exacerbation of liver damage.