肝移植手术治疗肝癌:附70例报告

Orthotopic liver transplantation in the treatment of hepatic cancer:a report of 70 cases

目的 总结肝移植手术治疗肝癌的临床经验，探讨提高肝移植手术效果的措施。方法 回顾分析近3年间70例肝癌行肝移植者的临床资料。采用快速标准切取法行肝肾联合切取，UW或HTK液灌注并保存；均采用同种异体（尸体供肝）原位全肝移植；其中经典式41例，背驮式29例；注重肝移植的围手术期处理。结果 70例手术均获成功，供肝热缺血时间平均4．5min，冷缺血时间平均8h。与手术相关的并发症主要有：腹腔内出血2例，门静脉狭窄1例，胆道吻合口狭窄4例。手术后死亡3例（4．3％）。67例获随访12～33个月，平均21个月，肝癌复发10例，其中1例死亡。结论 经过选择的肝癌患者可行肝移植治疗。确保供肝质量是肝移植成功的前提，良好的血管和胆管重建技术是肝移植手术成功的关键，加强肝移植的围手术期处理可有效地减少并发症的发生。

Objective To summarize the clinical experience of liver transplantation in the treatment of hepatocellular carcinoma （ HCC ） . Methods From June 2004 to March 2007,70 consecutive HCC patients underwent liver transplantation in our hospital, including classic orthotopic liver transplantation in 41 cases, and piggyback liver transplantation in 29 cases. All data of patients were retrospectively analyzed. Results All liver transplantation were successfully conducted . The average warm ischemia duration was 4.5 minutes, and cold ischemia duration was 8 hours. There were 3 cases of postoperative deaths. Surgical complications were intra-abdominal hemorrhage in 2 cases, and biliary anastomotic stricture in 4 cases. Sixty-seven cases were followed up for 12 - 33 （ average 21 ） months, 10 cases had recurrence of liver cancer after transplatation and 1 dead. Conclusions Liver transplatation can used on selected patients with HCC. Successful liver transplantation relies on good quality of liver graft, and idealized technique of vascular and bile duct reconstruction are key factors of liver transplantation. Proper postoperative management can effectively reduce the complications of operation.