CAJ | 학술논문

目的探讨肝移植术后肝脏局部淋巴细胞增生性疾病(LL-PTLD)的临床诊断和治疗策略.方法回顾性分析2003年7月至2011年7月间3000余例肝移植受者中发生的6例LL-PTLD的临床资料,并通过Pubmed和万方数据库检索到6例LL-PTLD患者的相关文献报道,共对12例LL-PTLD患者的诊断及治疗经验进行总结和分析.结果所有患者均经过病理检查确诊LL-PTLD.LL-PTLD的发生率约为0.2％ (6/3000).12例患者中,绝大部分患者给予了减量或停用免疫抑制剂和抗EB病毒治疗,其治疗反应较好；6例给予了全身化疗,其中3例死亡；4例行局部放射治疗后,肿瘤得到明显控制,患者均存活良好；3例行再次肝移植治疗,其中1例因淋巴瘤复发而死亡；1例行肝部分切除术,术后未出现淋巴瘤复发.结论肝移植后出现无法解释的肝门部梗阻时,应高度怀疑发生LL-PTLD,病理检查是诊断LL-PTLD的金标准；应尽早调整免疫抑制剂和抗EB病毒治疗,行局部放射治疗可以获得更好的治疗效果.
목적 탐토간이식술후간장국부림파세포증생성질병(LL-PTLD)적림상진단화치료책략.방법 회고성분석2003년7월지2011년7월간3000여례간이식수자중발생적6례LL-PTLD적림상자료,병통과Pubmed화만방수거고검색도6례LL-PTLD환자적상관문헌보도,공대12례LL-PTLD환자적진단급치료경험진행총결화분석.결과 소유환자균경과병리검사학진LL-PTLD.LL-PTLD적발생솔약위0.2％ (6/3000).12례환자중,절대부분환자급여료감량혹정용면역억제제화항EB병독치료,기치료반응교호；6례급여료전신화료,기중3례사망；4례행국부방사치료후,종류득도명현공제,환자균존활량호；3례행재차간이식치료,기중1례인림파류복발이사망；1례행간부분절제술,술후미출현림파류복발.결론 간이식후출현무법해석적간문부경조시,응고도부의발생LL-PTLD,병리검사시진단LL-PTLD적금표준；응진조조정면역억제제화항EB병독치료,행국부방사치료가이획득경호적치료효과.
Objective To analyze the clinical diagnosis and treatment strategies of liver-localized posttransplantation lymphoproliferative disease (LL-PTLD).Methods Six cases of LL-PTLD from more than 3000 cases of liver transplant recipients from July 2003 to July 2011 were retrospectively analyzed.Other six cases of LL-PTLD were retrieved through Pubmed and Wanfang.The diagnosis and treatment of 12 cases of LL-PTLD were summarized and analyzed.Results All patients with LL-PTLD were diagnosed pathologically.The incidence of LL-PTLD was 0.2％ (6/3000).Among 12 patients,immunosuppressant and anti-EB virus treatment was reduced or withdrawn in the vast majority of patients,and treatment response was satisfactory.Systemic chemotherapy was given in 6 cases,and three of them died.Local radiation therapy was given in 4 cases,the tumor was significantly controled,and patients survived.Secondary liver transplantation was performed on 3 cases: 1 case died of recurrent lymphoma,and one case received partial hepatectomy and no lymphoma recurred.Conclusion For cases with obstructive symptoms of fever and chills associated with jaundice without reasonable explanation,LL-PTLD is suspected and diagnosed by liver biopsy.Basic treatments such as adjustment of immunosuppressive agents and anti-viral therapy are recommended as early as possible.Local radiation therapy is a treatment method of LL-PTLD,which can obtain a satisfactory therapeutic effect.