肝癌肝移植Milan标准的临床意义探讨  

Clinical study of Milan criteria for liver transplantation

作　　者：沈中阳[1] 郑虹[1] 王政禄[1] 沈文[1] 朱志军[1] 邓永林[1] 潘澄[1] 包福宽[1] 

机构地区：[1]天津市第一中心医院器官移植中心,300192

出　　处：《中华外科杂志》2007年第23期1615-1618,共4页Chinese Journal of Surgery

基　　金：天津市科技发展计划资助项目(05ZHTGCG00300);天津市卫生局科技基金(03KY01)

摘　　要：目的探讨肝癌肝移植 Milan 标准的临床应用价值和注意事项。方法回顾性分析2001年12月至2005年11月术前 CT 检查符合 Milan 标准的125例肝细胞癌行肝移植患者的临床资料,对比影像学与病理学检查结果的差别及其对患者生存时间的影响。结果 125例患者中,切除肝脏病理检查证实符合 Milan 标准者97例,超出 Milan 标准者26例,2例未发现癌灶最终诊断为结节状肝硬化,准确率为77.6%。影像学与病理学符合 Milan 标准的肝移植患者的1、2、3、4和5年生存率分别为92.0%和92.8%、87.2%和90.7%、86.4%和89.7%、86.4%和89.7%、86.4%和89.7%,两组间生存率无明显差别(P>0.05)。病理学上超出 Milan 标准的患者1、2、3、4和5年生存率分别为73.0%、65.4%、61.5%、61.5%和61.5%,与病理学符合及影像学检查符合组间均存在明显差异(P<0.05)。结论术前螺旋 CT 诊断符合 Milan 标准的肝细胞癌患者肝移植术后生存良好,但应进一步提高诸如门静脉主要分支癌栓、淋巴结转移等导致病期误判因素的诊断水平。Objective To investigate the value and deficiency of Milan criteria for liver transplantation in patients with hepatocellular carcinoma （HCC）. Methods Between December 2001 and November 2005,125 patients underwent orthotopic liver transplantation （OLT）, who measured up Milan criteria with preoperation computerized tomography（CT） scaning. The results of pre-transplant multidetector CT scan and post-transplant pathology were retrospectively analyzed, and survival rates were compared. Results Pathology examination certificated that 97 cases met Milan criteria（77.6% ） ,26 cases exceeded Milan criteria,and the other 2 cases were diagnosed as nodular cirrhosis. The 1-,2-,3-,4- and 5- year survival rates for those met pre-transplant multidetector CT scanning pre-transplant met Milan criteria vs. those met post-transplant pathology post-transplant criteria were 92. 0% vs. 92. 8% ,87.2% vs. 90.7%, 86. 4% vs. 89.7%, 86. 4% vs. 89.7%, and 86.4% vs. 89.7%, respectively. There was no statistic significant difference（P 〉0. 05）. The 1-,2-,3-,4- and 5-year survival rates were 73.0% ,65.4% ,61.5%, 61.5% and 61.5% ,for those pathology exceed Milan criteria respectively. The difference between this group and each of the above two were statistically significant （ P 〈 0. 05）. Conclusions The prognosis of OLT for HCC is good for those met Milan criteria by pre-transplant multidetector CT. Factors leading to poor prognosis such as portal vein tumor thrombi and lymphatic metastasis should be accurately evaluated avoiding for misjudgement.

关 键 词：癌 肝细胞 肝移植 病理学 电子计算机体层扫描 

分 类 号：R735.7[医药卫生—肿瘤]