肝癌一期活体肝移植与切除后复发行活体肝移植疗效的系统评价  

Primary living donor liver transplantation for hepatocellular carcinoma versus living donor liver transplantation for postresection recurrent hepatocellular carcinoma: A systematic review

作　　者：魏续福[1] 蒲俊良 郭振[1] 牟童[1] 李婷婷[1] 朱迪[1] 吴忠均[1] Wei Xufu Pu Junliang Guo Zhen Mou Tong Li Tingting Zhu Di Wu Zhongjun(Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院肝胆外科,400016

出　　处：《中华移植杂志（电子版）》2017年第2期103-108,共6页Chinese Journal of Transplantation(Electronic Edition)

基　　金：重庆市科委社会事业与民生保障科技创新专项(CSTC;2015shmszx120019)

摘　　要：目的评价肝癌一期活体肝移植(LDLT)与切除后复发行LDLT治疗的疗效。方法根据文献纳入标准,纳入4项临床同期非随机对照试验,合计639例患者,采用Rev Man5.3软件对资料进行统计分析。结果 Meta分析结果表明,肝癌一期LDLT术后出血发生率相对于肝癌切除后复发行LDLT更低(RR=0.36,95%CI:0.19~0.68),P<0.05);二者术后血管并发症及胆道并发症比较差异均无统计学意义(RR=0.41,95%CI:0.13~1.36,P>0.05;RR=0.80,95%CI:0.47~1.36,P>0.05);二者围术期死亡率差异无统计学意义(RR=1.24,95%CI:0.40~3.88,P>0.05)。肝癌一期LDLT术后3年生存率高于肝癌切除后复发行LDLT(RR=1.28,95%CI:1.02~1.61),P<0.05),但术后5年生存率差异无统计学意义(RR=1.10,95%CI:0.92~1.33,P>0.05);二者术后3、5年无瘤生存率差异均无统计学意义(RR=1.23,95%CI:0.91~1.68,P>0.05;RR=1.21,95%CI:0.89~1.64,P>0.05)。结论肝癌切除后复发行LDLT与肝癌一期LDLT的安全性和可靠性相当。Objective To compare the effectiveness and advantage of living donor liver transplantation（ LDLT） for postresection recurrent hepatocellular carcinoma（ HCC） with primary LDLT for HCC patients. Methods Acccording to the including criteria,4 retrospective studies involving 639 patients were included. Rev Man 5. 3 software was used for data analysis. Results We conducted subgroup analysis based on outcome measures and interventions. Comparing with LDLT for postresection recurrent HCC,primary LDLT had a lower incidence rate of postoperative bleeding（ RR = 0. 36,95% CI： 0. 19-0. 68,P〈0. 05）. The incidence rates of vascular complication and biliary complication were similar（ RR = 0. 41,95% CI： 0. 13-1. 36,P〉0. 05; RR = 0. 80,95% CI： 0. 47-1. 36,P〉0. 05）. Likewise,perioperative mortalities did not significantly differ between them（ RR = 1. 24,95% CI： 0. 40-3. 88,P〉0. 05）. However,3-year survival rate was higher among patients who underwent primary living donor liver transplantation（ RR = 1. 28,95% CI： 1. 02-1. 61,P〉0. 05）.The 5-year survival rate and 3,5-year disease-free survival rates showed no statistically significant difference between them（ RR = 1. 10,95% CI： 0. 92-1. 33,P〉0. 05; RR = 1. 23,95% CI：0. 91-1. 68,P〉0. 05; RR = 1. 21,95% CI： 0. 89-1. 64,P〉0. 05）. Conclusion The long-term effect of LDLT for postresection recurrent HCC is equivalent to primary LDLT,and this therapeutic method is safe and reliable.

关 键 词：肝移植 活体肝移植 原发性肝癌 术后复发 系统评价 

分 类 号：R735.7[医药卫生—肿瘤]