Gringeri Enrico, Boetto Riccardo, Bassi Domenico, D'Amico Francesco Enrico, Polacco Marina, Romano Maurizio, Neri Daniele, Feltracco Paolo, Zanus Giacomo, Cillo Umberto
Azienda Università di Padova, Italy.
Prog Transplant. 2014 Jun;24(2):142-5. doi: 10.7182/pit2014632.
Liver transplant is the preferred treatment for hepatocellular carcinoma in patients with cirrhosis, as both neoplastic and cirrhotic liver tissue can be removed. Treatment of recurring neoplasms is a difficult issue, especially in long-term survivors of liver transplant. No consensus has been reached on the treatment of recurrent hepatocellular carcinoma. Although patients with extrahepatic metastases are generally not candidates for local therapy, successful multimodal salvage therapy including resection or ablation can be achieved in liver transplant recipients with local recurrence of hepatocellular carcinoma. Microwave ablation is safe and effective for treating unresectable hepatocellular carcinoma, achieving excellent results in local disease down-staging or as a "bridge" to liver transplant, with no significant differences in local recurrence and complications compared with the more commonly used radiofrequency ablation. A patient with local recurrence of hepatocellular carcinoma 36 months after liver transplant for multifocal hepatocellular carcinoma and cirrhosis due to hepatitis C was successfully treated with laparoscopic microwave ablation without any postoperative complications. The patient is disease free 24 months after microwave ablation.
肝移植是肝硬化患者肝细胞癌的首选治疗方法，因为肿瘤性和肝硬化肝组织均可切除。复发性肿瘤的治疗是一个难题，尤其是在肝移植长期存活者中。对于复发性肝细胞癌的治疗尚未达成共识。虽然肝外转移患者一般不适合局部治疗，但对于肝细胞癌局部复发的肝移植受者，可通过包括切除或消融在内的成功多模式挽救性治疗实现。微波消融治疗不可切除肝细胞癌安全有效，在局部疾病降期或作为肝移植“桥梁”方面取得了优异效果，与更常用的射频消融相比局部复发和并发症无显著差异。一名因多灶性肝细胞癌和丙型肝炎肝硬化接受肝移植36个月后出现肝细胞癌局部复发的患者，成功接受了腹腔镜微波消融治疗，术后无任何并发症。微波消融术后24个月患者无疾病复发。
