He Xiao-shun, Zhang Shao, Zhu Xiao-feng, Ji Yong, Zeng Ji-xiao, Ma Yi, Wang Dong-ping, Ju Wei-qiang, Wu Lin-wei, Li Zhi, Huang Jie-fu
Organ Transplantation Center of the First Affiliated Hospital, SUN Yat-Sen University, Guangzhou 510080, China.
Zhonghua Wai Ke Za Zhi. 2006 Mar 1;44(5):302-5.
To explore the feasibility and outcome of combined hepatectomy, orthotopic liver transplantation and Whipple's pancreatoduodenectomy for radical excision of cholangiocarcinoma.
A 35-year-old female patient with unresectable cholangiocarcinoma underwent curative radical operation, which includes hepatectomy, orthotopic liver transplantation and pancreaticoduodenectomy of hilar bile duct carcinoma; immunosuppression followed an induction protocol with FK506 and steroids. Lamivudine and HBIg were used to prevent hepatitis B virus from infection again.
Pathologic examination revealed low differentiated cholangiocarcinoma and immunohistochemistry stains demonstrated positive expression of cytokeratin 9 and 17, carcinoembryonic antigen and the hepatocyte protein was negative. Neither the margins of resection nor the periductal lymph nodes were involved. The liver showed evidence of cholestasis and metastasis nod. The patient was hospitalized 32 days and came back to the previous work. He has been followed up for more than 14 months up to now and is currently alive without any evidence of recurrent cancer.
For some selected unresectable Klatskin's tumors, combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation was justified. The radical methods maybe provide long-time survival and curative effect. Nevertheless, because of possible tumor recurrence and ethical controversy, the combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation procedure has to be applied only with caution and indications.
探讨联合肝切除术、原位肝移植术和惠普尔胰十二指肠切除术根治性切除胆管癌的可行性及疗效。
一名35岁不可切除胆管癌女性患者接受了根治性手术，包括肝切除术、原位肝移植术及肝门部胆管癌胰十二指肠切除术；采用FK506和类固醇进行诱导免疫抑制。使用拉米夫定和乙肝免疫球蛋白预防乙肝病毒再次感染。
病理检查显示为低分化胆管癌，免疫组化染色显示细胞角蛋白9和17、癌胚抗原呈阳性表达，肝细胞蛋白呈阴性。切缘及胆管周围淋巴结均未受累。肝脏有胆汁淤积和转移结节迹象。患者住院32天，恢复至术前工作状态。截至目前已随访14个月以上，患者存活，无癌症复发迹象。
对于一些选定的不可切除的肝门部肿瘤，联合肝切除术、胰十二指肠切除术和原位肝移植术是合理的。这种根治性方法可能提供长期生存和疗效。然而，由于可能存在肿瘤复发及伦理争议，联合肝切除术、胰十二指肠切除术和原位肝移植术必须谨慎应用并严格掌握适应证。
