钇-90微球放射栓塞联合靶向和免疫治疗后成功肝移植：一例报道并文献复习

doi:10.3969/j.issn.1009-976X.2024.01.011

摘要/Abstract

摘要： 目的探讨晚期肝癌经钇-90微球放射栓塞（Y90-RE）联合靶向和免疫治疗后成功肝移植治疗的临床资料并复习相关文献。方法回顾性分析我中心一例晚期肝癌患者经Y90-RE联合靶向和免疫治疗后成功行肝移植治疗,对相关治疗方法及术后病情变化特点进行分析,并总结国内外最新文献进展。结果患者为41岁中年男性,经Y90-RE联合靶免治疗后行肝移植术,围手术期予人免疫球蛋白冲击治疗,术后早期予他克莫司+糖皮质激素联合免疫抑制方案。患者术后2周内肝功能逐渐好转后,在术后第15天和第68天出现转氨酶轻度升高,肝穿刺病理提示轻度急性排斥反应,均通过予加强免疫抑制治疗后好转。现随访6月余,肝功能正常,未见肿瘤复发。结论 Y90-RE联合靶免治疗可为晚期肝癌患者提供一种治疗选择方案。

关键词: 肝癌, 肝移植, 钇-90微球放射栓塞治疗, 靶免治疗, 排斥反应

Abstract: Objective To discuss successful liver transplantation in advanced hepatocellular carcinoma patients after yttrium-90 microsphere radioembolization （Y90-RE） combination of targeted and immunotherapy： a clinical case report and literature review. Methods A retrospective analysis of a case of advanced hepatocellular carcinoma patient who underwent successful liver transplantation after Y90-RE combination of targeted and immunotherapy at our center was performed. The relevant treatment methods and postoperative disease changes were analyzed, and the latest domestic and international literature progress was summarized. Results The patient was a 41-year-old middle-aged man. After Y90-RE combination target-immune therapy, he underwent liver transplantation. During the perioperative period, human immunoglobulin pulse therapy was administered, and a combined immunosuppressive scheme of tacrolimus and glucocorticoids was given early after surgery. The patient′s liver function gradually improved within 2 weeks after surgery. However, mild elevations of transaminases were detected on the 15th and 68th days after surgery, accompanied by mild acute rejection identified by liver biopsy. Both episodes were resolved by strengthening immunosuppressive treatment. Now, after 6 months of follow-up, the patient′s liver function is normal, and no tumor recurrence is observed. Conclusion Y90-RE combined target-immune therapy can provide a treatment option for advanced hepatocellular carcinoma patients.

Key words: liver cancer, liver transplantation, Yttrium-90 microsphere radioembolization, targeted immunotherapy, rejection reaction

中图分类号:

R681.5

陈焕权, 何才华, 代天星, 黄文薮, 袁峰, 王晓明, 罗燕君, 汪国营. 钇-90微球放射栓塞联合靶向和免疫治疗后成功肝移植：一例报道并文献复习[J]. 岭南现代临床外科, 2024, 24(01): 69-75.

CHEN Huan-quan, HE Cai-hua, DAI Tian-xing, HUANG Wen-sou, YUAN Feng, WANG Xiao-ming, LUO Yan-jun, WANG Guo-ying. Successful liver transplant after Yttrium-90 microsphere radioembolization combined with targeted and immunotherapy： a case report and literature review[J]. Lingnan Modern Clinics In Surgery, 2024, 24(01): 69-75.

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