原位肝移植治疗原发性肝癌68例报告

Orthotopic liver transplantation for primary liver carcinoma with 68 cases

目的:探讨原位肝移植在原发性肝癌治疗中的价值。方法:对68例接受肝移植原发性肝癌病例进行回顾性分析,随访6个月以上,对术后患者存活情况进行分析。结果:68例肝移植手术均获成功,无围手术期死亡,54例存活至今,最长无瘤存活已达65个月。小肝癌复发率为2.2%(1/46),大肝癌复发率为54.5%(12/22),其中肝内门脉分支有癌栓者复发率为66.6%(4/6),门脉主干有癌栓者为100%(3/3);小肝癌患者的存活时间显著长于大肝癌(P=0.000)。此外,肝癌肝移植术后及早停用类固醇激素,并维持抗排斥药物在较低的药物浓度也可能有助于减少肿瘤术后复发。结论:原位肝移植是治疗肝癌特别是小肝癌的有效手段,对于门静脉主干无癌栓的中晚期肝癌也能起到积极治疗作用。

Objective：To explore the value of orthotopic liver transplantation in the treatment of primary liver carcinoma. Methods： Clinical data of 68 cases of primary liver carcinoma receiving liver transplantation were analysed retrospectively. All the patients were followed for at least 6 months and their survival rate were studied. Results：All the operations were conducted successfully without any death within peri-operative periods, 54 cases survive and the longest time of tumor free has reached to 34 months. Cancer reoccurred in one patient in small liver carcinoma group 9 months after the operation with recurring rate 2. 2% ; while 12 cases reoccurred in big liver carcinoma group with recurring rate at 54. 5 %. Among the big liver carcinoma group, the reoccurring rate reached at 66. 6% and 100% in patients with tumor thrombi formation in portal vein branch and main portal vein, respectively. Overall survival of patients in small liver carcinoma group was signifcant longer than that of patients in big liver carcinoma group（ P = 0. 000 ）. Moreover, stopping the use of steroids in earliest time and maintaining the low fk506 level in blood in primary liver carcinoma patients who received liver transplantation could reduce the tumor reoccurring rate. Conclusion：Orthotopic liver transplantation is an effective way for the treatment of small liver carcinoma and it could also prolong the life of advanced liver cancer patients without rumor thrombi formation in main portal vein.