病毒性肝炎、肝癌与肝移植

原位肝移植已走过42年历程。目前肝移植1年存活率已攀升到88%,手术死亡率已降至0。不伴有肝硬化和能切除的肝细胞癌患者应首选肝切除术;有肝硬化者需行肝移植;晚期肝癌不宜肝移植。手术前、后联合应用乙型肝炎免疫球蛋和拉米夫定,可使患乙型肝炎者接受肝移植的长期疗效与其他肝病受者相媲美。没有肝移植条件的医院不提倡开展肝移植。

Liver transplantation for viral hepatitis and hepatic cancer

Orthotopic liver transplantation(OLT) has been performed for 42 years.Survival rates have climbed to as high as 88% at 1-year and operative mortality rates have dropped to as low as 0%.Liver resection should still be considered the first-line treatment for patients with hepatocellular carcinoma(HCC) in non-cirrhotic and resectable livers.Liver transplantation must be the preferred approach for cirrhotic livers.OLT for HCC at a more advanced stage is not indicated.Combination therapy with hepatitis B immune globulin(HBIG) and lamivudine for hepatitis B virus(HBV) patients before and after OLT has been reported a survival benefit as compared to non-HBV recipients.Liver transplantation should not be advocated at the hospitals without primary working conditions.