肝门胆管癌的肝移植治疗：附6例报告

背景与目的 不可切除的肝内胆管癌（hCCA）患者可考虑行肝移植治疗，但在某些方面仍存在争议。因此，本研究总结6例肝移植治疗不可切除hCCA临床疗效，以期为临床诊治提供参考。方法 回顾性分析2015年1月—2021年3月6例在上海交通大学医学院附属瑞金医院行肝移植治疗并规律随访的hCCA患者临床病理资料与生存情况。结果 6例肝移植术式均为原位经典全肝移植，术后病理：肿块型2例，管壁浸润型2例，内生型2例；肿瘤直径>3 cm者4例；周围神经浸润2例；门静脉侵犯3例；肝内转移2例；腺鳞癌1例，腺癌5例。组织学分级3例中分化G2，3例低分化G3；pTMN分期分别为II期1例，IIIa期1例，IIIb期1例，IIIc期2例，IV期1例。随访期间，3例存活，其中2例合并肝硬化失代偿内生息肉型腺癌患者获得长期无瘤生存，1例肿块型腺癌患者术前经新辅助放化疗后目前无瘤存活20个月；死亡3例，其中1例肿块型腺鳞癌患者术后存活18个月，2例管壁浸润型腺癌患者分别存活2个月与24个月。术前减黄操作，术后联用免疫抑制剂和化疗药物对于患者生存期无明显影响。结论 hCCA患者中，对于合并肝硬化的内生息肉型腺癌，且术前排除淋巴结转移者，即使术前不行新辅助放化疗直接行肝移植也可取得较好的疗效，但对有淋巴结转移与神经周围浸润者疗效差。

Liver transplantation for hilar cholangiocarcinoma: a report of 6 cases

Background and Aims Liver transplantation has been proposed as an alternative treatment for patients with unresectable hilar cholangiocarcinoma (hCCA), but it is still controversial in some aspects. Therefore, this study was conducted to summarize the clinical efficacy of liver transplantation for 6 patients with unresectable hCCA, so as to provide information for clinical decision-making.Methods The clinicopathologic data and survival status of 6 hCCA patients who underwent liver transplantation and regular follow-up in Shanghai Jiaotong University School of Medicine affiliated Ruijin Hospital from January 2015 to March 2021 were retrospectively analyzed.Results All the 6 patients underwent the standard orthotopic whole liver transplantation. The postoperative pathology showed mass-forming type lesion in 2 cases, infiltrating type lesion in 2 cases and endophytic type lesion in 2 cases; the diameter >3 cm in 4 cases; peripheral nerve invasion in 2 cases, portal vein invasion in 3 cases and intrahepatic metastasis in 2 cases; adenosquamous carcinoma in 1 case and adenocarcinoma in 5 cases; G2-moderately differentiated histological grade in 3 cases and G3-poor differentiated histological grade in 3 cases; pTMN stage II in 1 case, stage IIIa in 1 cases, stage IIIc in 2 cases and stage IV in 1 case. During follow-up, 3 cases were alive, of whom, long-term tumor-free survival was achieved in 2 cases with endophytic and polypoid type adenocarcinoma and decompensated cirrhosis, and 1 case with mass-forming type adenocarcinoma undergoing preoperative neoadjuvant chemoradiotherapy survived with disease free for 20 months by far; 3 cases were dead, of whom 1 case with mass-forming type adenosquamous cholangiocarcinoma survived for 18 months after operation, and 2 cases with biliary tract infiltration survived for 2 months and 24 months, respectively. Preoperative biliary drainage and combination of immunosuppressor and chemotherapy after surgery exerted no obvious effect on the survival of the patients.Conclusion In hCCA patients, liver transplantation may offer better results to those with endophytic and polypoid type adenocarcinoma and decompensated liver cirrhosis as well as exclusion of lymph node metastasis, even no preoperative neoadjuvant chemoradiotherapy is given, but yield dismal results in those with lymph node metastasis and peripheral infiltration.