Liver transplantation and _'s treatment of hepatocarcinoma

Liver transplantation and _'s treatment of hepatocarcinoma
First, background
At the early stage for development of liver transplantation, people can expecting to excise with the whole liver and liver transplantation is treated, thought liver tumour not excised with some liver in the past. So in order to choose the case of liver transplantation, it is often enormous limitation progress period liver tumour. Though these patients have no phenomenon shifted outside liver during liver transplantation, clinical practice of liver transplantation demonstrate patient these overwhelming majority die of tumour and recur in short term while being postoperative soon. The result of study is clearly illustrated, the inhibition of the immunological function accelerates the growth of tumour and promotes tumour to recur.
With constant improvement that immunological function inhibit, liver transplantation used in good the intersection of venereal disease and example (Zhai have liver cirrhosis case of liver tumour mainly) Survivings long-term extraordinary good. This makes adaptation card of liver transfer operation increase constantly, so, liver transfer operation and to supporting the demand for the liver to be stingy greatly, and the patient who suffered from the benign hepatopathy more and more, when waiting for liver transplantation, die from the liver and decline because of can't wait to support the livering.
Now, treat liver tumour by liver transplantation, it very difficult to can relieve the condition as treating the motivation of liver tumour of period of limitation progress in the liver in a short time by liver transplantation. Transplanting to a surgeon should choose the liver tumour case to do liver transplantation strictly. Their purpose should be very clear, but through the liver tumour case chosen strictly, thus the long-term survival rate close to postoperative good venereal disease example liver transplantation.
Second, primary liver cellulous hepatocarcinoma (hepatocarcinoma)
Primary liver cellulous hepatocarcinoma is the most common sending malignant tumour in the liver originally, also liver transplantation treats the most common surgery indication of malignant liver tumour. Liver transplantation treats hepatocarcinoma, following several points need detailed theory.
1.The case of liver transplantation is chosen: The early experience of liver transplantation has already been clearly proved: Some factors can influence the long-term curative effect of liver transplantation. These factors should be considered while choosing liver transplantation case.
(1)The diameter of tumour: The diameter size of tumour obviously influences the postoperative long-term survival rate of liver transplantation. One group registers 410 cases of hepatocarcinoma dealt with by liver transplantation to reveal recently: Smaller than 3 cm in the diameter of hepatocarcinoma, in 3- 5 cm and case which is greater than 5cm, the survival rate is 59.9% respectively its 5, 48.7% and 32.6%. How many centimetres of taboo cards that is liver transplantation are exceeded about the diameter of hepatocarcinoma, have unanimous standard yet at present, but majority transplant centre stipulate single shot the intersection of tumour and diameter less than the intersection of 5 cm and upper limit in liver transplantation.
(2)The frequently-occurring disease cooking stove of tumour: Bad after having hepatocarcinoma case of the cooking stove of venereal disease of occuring frequently to transplant. But Mazzaferro,etc. has reported 48 cases of hepatocarcinoma and transplanted the case, among them the diameter of the single tumour is less than 5 cm, but the diameter of the multiple tumour is smaller than 3 cm and total number of tumours and does not exceed 3, the survival rate can be up to 75% its 4, and the recuring rate of tumour is only 8%. So, even if tumour occurs frequently, but if the diameter of tumour is smaller and number is less, it is not a taboo card of liver transplantation.
(3)Blood vessel and lymph node are infringed: Because its prognosis of liver transplantation of infringing blood vessel and lymph node is very bad, so, transplant to a surgeon and think that there are blood vessel and lymph node that should show the taboo card as liver transplantation to infringe in majority.
(4)Shift outside the liver: It is absolutely avoiding the card of liver transplantation to shift outside the liver.
(5)The organization of tumour splits up: The organization of tumour differentiates the intensity, though have prognostic guidance meanings to treat hepatocarcinoma in liver transplantation, but the reason why the patient in need of liver transplantation declines because of the liver, often can't carry on liver tumour and live and examine. Live, examine, may cause the issue that tumour is planted, so can know patient's tumour in front of the skill. Organization split up situation uncommon. And organization differentiates, is usually only regarded as the indicator of the postoperative prognosis tumour.
(6)B-mode and hepatitis C: Because effective antiviral therapeutic method has appeared at present, B-mode and hepatitis C has already no longer been taboo cards of liver transfer operation.
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