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首页> 外文期刊>Transplantation Proceedings >How can we treat a patient with liver cirrhosis (Hepatitis C Virus), hepatocellular carcinoma, and synchronous colon cancer?
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How can we treat a patient with liver cirrhosis (Hepatitis C Virus), hepatocellular carcinoma, and synchronous colon cancer?

机译：我们该如何治疗肝硬化（丙型肝炎病毒），肝细胞癌和同步性结肠癌患者？

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Introduction: The coexistence of liver cirrhosis with hepatocellular carcinoma (HCC) and colon cancer (Ca), which is a rare clinical condition, was treated in a liver transplant recipient. Patients and Methods: A 46-year-old man, diagnosed incidentally during an ultrasound (US) examination with a 3.5-cm HCC in segment VII related to chronic hepatitis C virus (HCV), was referred for liver resection. He underwent a laparoscopic protocol evaluation for liver cirrhosis. Liver appearance and biopsy of the left lobe showed Child B/C liver cirrhosis. Because he fulfilled the Milan criteria, we suggested an orthotopic liver transplantation (OLT). During protocol colonoscopy, we discovered an ulcerative sigmoid colon Ca. Three weeks after completing the pre-OLT assessment he underwent an OLT and was discharged home on day 9 on an immunosuppressive regimen of Everolimus, Myfortic, and Prezolone. Two months after transplantation, the patient underwent a sigmoidectomy and for nearly 1 month thereafter received chemotherapy for colon Ca (6 cycles of FOLFOX:Folinic Acid+Fluorouracil+Oxaliplatin). One and a half years after OLT, patient was in good condition but presented with an increased alpha fetoprotein (a-FP) without other findings. A couple of months later we discovered a colon Ca recurrence and 3 small liver metastases. Patient underwent a bowel resection with Hartmann's procedure. Almost immediately after the last operation, he was found to suffer multiple myeloma. He underwent chemotherapy for both malignancies with good responses, but a few months later died of severe sepsis. Discussion: The relevant literature regarding treatment of liver cirrhosis complicated with HCC and synchronous colon Ca reveals poor and controversial outcomes. Our patient underwent chemotherapy immediately after colon resection in the presence of with a good functioning liver. Although his condition was satisfactory after OLT, the optimal treatment of such complicated patients is as yet uncertain.
机译：简介：在肝移植接受者中治疗了肝硬化与肝细胞癌（HCC）和结肠癌（Ca）并存，这是一种罕见的临床疾病。患者和方法：一名46岁的男子在超声（美国）检查中偶然被诊断出与慢性丙型肝炎病毒（HCV）有关的VII节中的3.5厘米HCC，被转诊为肝切除术。他接受了肝硬化腹腔镜检查方案评估。肝外观和左叶活检显示儿童B / C肝硬化。因为他符合米兰标准，所以我们建议进行原位肝移植（OLT）。在方案结肠镜检查过程中，我们发现了溃疡性乙状结肠钙。在完成OLT前评估后三周，他接受了OLT，并在第9天接受了依维莫司，Myfortic和Prezolone的免疫抑制方案回家。移植后两个月，患者接受了乙状结肠切除术，此后近一个月接受了结肠钙的化疗（6个周期的FOLFOX：亚叶酸+氟尿嘧啶+奥沙利铂）。 OLT一年半后，患者情况良好，但出现了甲胎蛋白（a-FP）升高，而没有其他发现。几个月后，我们发现了结肠Ca复发和3个小肝转移。患者接受了Hartmann手术的肠切除术。上次手术后几乎立即发现他患有多发性骨髓瘤。他对两种恶性肿瘤都接受了化疗，反应良好，但几个月后死于严重败血症。讨论：有关肝硬化合并肝癌和同步性结肠钙的治疗的相关文献显示不良和有争议的结果。我们的患者在肝功能良好的大肠切除术后立即进行了化疗。尽管他在OLT后的病情令人满意，但是对于这种复杂患者的最佳治疗仍不确定。

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