不可切除肝门胆管癌联合肝移植治疗

D. Granov, I. I. Tileubergenov, V. N. Zhuikov, A. Sheraliev, A. Polikarpov, A. Moiseenko
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摘要

目的:探讨肝移植后新辅助治疗不可切除肝门胆管癌的经验。材料和方法。2017年至2021年,在俄罗斯格拉诺夫放射与外科技术科学中心,6例不可切除克拉特金瘤肝移植患者纳入治疗方案。新辅助治疗包括胆内光动力治疗(PDT),以及局部和全身化疗。每种方法至少使用3次,持续4 ~ 5个月,并进行放射学评估和CA 19-9水平测量。当肿瘤标志物降低,或者没有疾病进展的放射学迹象并且没有急性胆管炎时,患者被放置在等待名单上。受术者接受了腹腔镜下腹部肿瘤检查,并对肝十二指肠韧带淋巴结进行了紧急形态学检查。在无肝外扩散的情况下,根据经典技术进行肝内腔旁、主动脉旁和肝十二指肠淋巴清扫,通过孤立的小肠Roux袢进行胆道消化吻合。3例患者均为男性,年龄40 ~ 55岁,平均48岁。从开始治疗到移植的平均时间为9.3个月(6至14个月)。干预时CA 19-9的平均水平为81.3 IU/mL(8 ~ 212)。在三名患者中,尽管接受了治疗,但CA 19-9水平在四个月内平均增加了一倍以上。根据计算机断层扫描RECIST评估的数据,两名患者显示疾病进展。1例患者通过诊断性腹腔镜检查发现癌变。在三名患者中,CA 19-9水平下降了四倍以上。其中2例经放射学证实病情稳定,1例部分缓解。一名患者在移植后3年死于败血症,原因是继发性胆汁性肝硬化和胆道脓肿,无进展迹象。2例患者在6个月和21个月后仍存活,无肿瘤进展迹象。对于不可切除的克拉特金肿瘤,通过使用新辅助治疗,可以有效地控制肿瘤的生物活性
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Combined treatment of unresectable hilar cholangiocarcinoma with subsequent liver transplantation
Objective: to demonstrate the experience of unresectable hilar cholangiocarcinoma treatment using neoadjuvant therapy followed by liver transplantation (LT).Materials and methods. From 2017 to 2021, six patients were included in the treatment protocol for unresectable Klatskin tumor followed by liver transplantation at Granov Russian Scientific Center for Radiology and Surgical Technology. The neoadjuvant therapy included endobiliary photodynamic therapy (PDT), as well as regional and systemic chemotherapy. Each method was used at least three times for 4 to 5 months with radiological evaluation and measurement of CA 19-9 levels. Patients were placed on the waiting list when the tumor marker reduced, or when there were no radiological signs of disease progression and there was no acute cholangitis. The recipients underwent laparoscopic abdominal revision for carcinomatosis and assessment of lymph nodes in the hepatoduodenal ligament with urgent morphological examination. Where there was no extrahepatic spread, LT was performed according to the classical technique with paracaval, para-aortic and hepatoduodenal lymphodissection, biliodigestive anastomosis by an isolated Roux loop of small intestine. The operation was performed in three patients, all of them were men aged 40 to 55 years (mean 48). The mean time from the start of treatment to transplantation was 9.3 months (range 6 to 14). Mean CA 19-9 level at the time of intervention was 81.3 IU/mL (8 to 212).Results. In three patients, CA 19-9 levels more than doubled on average over four months despite treatment. According to data from computed tomography RECIST assessment, two of the patients showed disease progression. In one patient, carcinomatosis was detected by diagnostic laparoscopy. In three patients, CA 19-9 levels decreased more than fourfold. Two of these patients were radiologically confirmed to have the disease stabilized, and one had a partial response. One patient died from sepsis three years after transplantation as a result of secondary biliary cirrhosis and biliary abscesses without signs of progression. Two patients are still alive after 6 and 21 months without signs of tumor progression.Conclusion. LT for unresectable Klatskin tumor is effective in controlling the bioactivity of the tumor through the use of neoadjuvant therapy
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