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Ghép gan cho ung thư biểu mô tế bào gan
Tóm tắt
Vai trò của ghép gan (LT) ở bệnh nhân bị ung thư biểu mô tế bào gan (HCC) đã tiến triển trong hai thập kỷ qua, và ghép gan đã trở thành một trong những phương pháp điều trị mang lại hiệu quả chữa khỏi cho bệnh nhân HCC. Kết quả ban đầu tương đối kém, nhưng những tiêu chí lựa chọn khắt khe hiện tại có thể cho kết quả xuất sắc. Bài đánh giá này sẽ thảo luận về những vấn đề gần đây trong lĩnh vực này, bao gồm (1) các yếu tố ảnh hưởng đến tái phát HCC sau LT; (2) hiệu quả của việc giảm giai đoạn HCC trước khi LT, bao gồm hóa tắc mạch hóa trị liệu (TACE) và thuyên tắc bằng sóng cao tần (RFA); và (3) ghép gan từ người cho sống so với ghép gan từ người hiến não chết cho bệnh nhân HCC. Các yếu tố quan trọng nhất đã được mô tả có ảnh hưởng đến sự sống sót sau LT bao gồm kích thước khối u, xâm lấn mạch máu và mức độ biệt hóa của khối u. Gần đây, các dấu hiệu khối u, bao gồm alpha-fetoprotein và des-gamma carboxy prothrombin, đã được báo cáo là các yếu tố dự đoán tái phát HCC sau LT. Hơn nữa, kinh nghiệm tích lũy với các liệu pháp tại chỗ như TACE và RFA như là các phương pháp cầu nối để LT, cùng với thời gian chờ giảm đi dưới hệ thống MELD điều chỉnh cho HCC (mô hình cho bệnh gan giai đoạn cuối) trong phân bổ nội tạng đã dẫn đến cải thiện kết quả. Với những tiến bộ gần đây trong ghép gan từ người hiến sống (LDLT), có thể sẽ có sự thay đổi rõ rệt trong vai trò của ghép gan đối với các khối u gan, đặc biệt là đối với HCC.
Từ khóa
#ghép gan #ung thư biểu mô tế bào gan #HCC #hóa tắc mạch hóa trị liệu #thuyên tắc bằng sóng cao tần #MELDTài liệu tham khảo
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