肝移植治疗原发性肝癌103例疗效观察  

Liver transplantation for hepatocellular carcinoma： a report of 103 cases

作　　者：武聚山[1] 卢实春[1] 王孟龙[1] 李宁[1] 夏仁品[1] 郭庆良[1] 赖威[1] 张毅[1] 杨光[1] 刘源[1] 

机构地区：[1]首都医科大学附属北京佑安医院,100054

出　　处：《中华肝胆外科杂志》2009年第10期748-750,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：2005年及2007年教育部留学回国人员科研启动基金资助;首都医科大学基础与临床合作基金资助（2006JL55）

摘　　要：目的比较不同受体选择标准肝癌肝移植的远期疗效，分析肝癌肝移植术后肿瘤复发相关因素。方法总结北京佑安医院2004年4月至2008年3月间的103例肝癌肝移植的临床资料，按照肿瘤的特征将其分为3组：符合米兰标准组（A组）、超出米兰标准但满足UCSF标准组（B组）和超出UCSF标准组（C组），比较3组的总体生存率及无瘤生存率，并分析影响远期预后的相关因素。结果103例肝癌肝移植总体1、2、3年存活率分别为84．0％、70．5％和60．2％。其中A组50例，1、2、3年生存率和无瘤生存率分别为93．4％、83．8％、73．2％和97．3％、93．9％、88．7％；B组17例，1、2、3年生存率和无瘤生存率分别为93．3％、79．4％、66．2％和86．7％、79．4％、66．2％；C组36例，1、2、3年生存率和无瘤生存率分别为67．0％、45．5％、34．1％和65．8％、50．0％、41．7％。远期生存率A组与B组比较无差异（P=0．631），A组、B组与C组比较具有统计学差异（P值分别为0．001，0．045）。结论米兰标准是肝癌肝移植最佳适应证，超出米兰标准但满足UCSF标准也可获得满意的远期疗效；肿瘤的分期和微血管侵犯是影响远期预后的风险因素。Objective To compare the long tern, survivals of orthotropic liver transplantation （OLT） in HCC patient within different selection criteria and analyze the risk factors of tumor recurrence after liver transplantation. Methods OLT was performed in 103 patients with HCC in our hospital between April 2004 and March 2008. The data were retrospectively analyzed with regard to the response to OLT and survival. The patients were divided into three groups according to the characteristics of tumor： group A （within Milan criteria）, group B （extra Milan criteria within UCSF criteria） and group C （beyond UCSF criteria）. Accumulative survival rate and tumor-free survivals were com- pared among the 3 groups. Result The 1-, 2 -,3-year accumulative survival rates of 103 patients were 84.0%, 70.5% and 60.2%, which were 93.4%, 83.8%, 73.2% in group A （n=50）, 93.3%, 79.4%, 66.2% in group B （n =17） and 67.0%, 45.5%, 34.1% in group C （n=36）, respectively. There was no significant difference in long term survival rate between group A and group B （P = 0. 631）, while significant difference between group A and group C （P =0. 001） or group B and group C （P=0. 045） was found. Conclusion HCC fulfilling Milan criteria is best indicated for liver transplantation, and satisfied outcomes cart be achieved for the HCC recipients exceeding Milan criteria but within UCSF criteria as well. Prognostic risk factors are tumor staging and microvascular invasion of the tumor.

关 键 词：肝移植 肝癌 生存率 

分 类 号：R686[医药卫生—骨科学]