超声评估门静脉与HCC患者肝移植预后的关系  

Prognostic value of portal vein involvement in patients undergoing liver transplantation for hepatocellular carcinoma

作　　者：马步云[1] 李晋[2] 卢强[1] 严律南[2] 罗燕[1] 彭玉兰[1] 

机构地区：[1]四川大学华西医院超声科,四川省成都市610041 [2]四川大学华西医院肝移植中心,四川省成都市610041

出　　处：《世界华人消化杂志》2010年第5期512-516,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨超声检查肝细胞癌(hepatocellular carcinoma,HCC)门静脉对肝移植患者预后的诊断价值.方法:收集2000-01/2006-10四川大学华西医院进行肝移植的HCC患者148例,结合患者超声、病理以及临床资料,对患者肝移植后生存情况进行回顾性分析.结果:全组随访时间2.8-69.5(平均16.4)mo.随访期间,肿瘤复发率为43.2%.超声检查无门静脉受累者102例(68.9%),门静脉肝内分支受累者32例(21.6%),门静脉主干受累者14例(9.5%).单因素COX模型分析结果显示:门静脉受累是对累积生存率和无瘤生存率有统计学意义的协变量(RR=2.673,P=0.000).多因素COX逐步回归分析结果显示:门静脉受累是对累积生存率(RR=2.426,P=0.000)和无瘤生存率(RR=2.258,P=0.000)有影响的独立因素.结论:门静脉受累是独立性的预后影响因素,超声检测HCC患者门静脉是否受累有助于患者适应证的选择.AIM：To evaluate the prognostic value of portal vein involvement in patients undergoing liver transplantation for hepatocellular carcinoma （HCC）.METHODS：One hundred and forty-eight HCC patients who underwent liver transplantation at West China Hospital of Sichuan University from January 2000 to October 2006 were included in the study.The pathological,clinical and ultrasound imaging data for these patients were analyzed retrospectively.RESULTS：The median follow-up was 16.4 months （range：2.8-69.5 months）.During the follow-up,the overall tumor recurrence rate was 43.2%.Ultrasound examination revealed intrahepatic portal vein involvement in 32 patients,main portal vein involvement in 14 patients,and no portal vein involvement in 102 patients.Univariate COX model analysis showed that portal vein involvement was an independent predictor of actuarial survival [relative risk （RR）=2.673,P=0.000] and recurrence-free survival （RR=2.951,P=0.000）.Multivariate COX proportional hazards model analysis also showed portal vein involvement was an independent predictor of actuarial survival （RR=2.426,P=0.000） and recurrence-free survival （RR=2.258,P=0.000）.CONCLUSION：Portal vein involvement is an independent prognostic factor for survival in patients undergoing liver transplantation for HCC.Ultrasound assessment of portal vein involvement can help identify indications for liver transplantation in patients with HCC.

关 键 词：超声检查 肝细胞癌 门静脉 肝移植 预后 

分 类 号：R735.7[医药卫生—肿瘤]