肝移植治疗肝细胞癌合并门静脉癌栓的疗效评价

Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus

目的评价肝移植治疗肝细胞癌合并门静脉癌栓患者的临床应用价值。方法回顾性分析2002年1月至2006年12月146例行肝移植术治疗肝细胞癌合并门静脉癌栓患者的临床资料，其中10例患者曾行肝切除术．8例患者围手术期死亡，予以排除。对其余128例患者进行了随访，分析影响患者存活率的相关因素。结果128例肝移植患者术后中位存活时间为13．0个月，术后6个月、1年、2年累积存活率分别为78．1％、51．6%和29．7%。单因素分析表明，癌栓分级、肿瘤大体类型、肿瘤数目是影响患者预后的主要危险因素；多因素分析显示，癌栓分级和肿瘤数目与患者术后累积存活率具有显著的相关性。结论现阶段肝细胞癌合并门静脉癌栓的患者行肝移植术远期疗效尚不满意，在供者资源严重短缺的条件下应限制应用。

Objective To evaluate the clinically applied value of liver transplantation for hepatocellular carcinoma （HCC） with portal vein tumor thrombus （PVVT）. Methods The clinical data of 146 HCC patients with PVTT undergoing liver transplantation from Jan. 2002 to Dec. 2006 were analyzed retrospectively. Ten cases of recurrent HCC after liver resection and 8 deaths during the operation were excluded from this study. The remaining 128 patients were followed up,and the relative risk factors influencing patients＇ survival were evalualed hy univariate and multivariate analysis. Results The median follow up periods of 128 palients were 13. 0 months. The 6-, 12 , and 24 month cumulative survival rate was 78. 1 %, 51.6 % and 29.7 % respectively. The univariate analysis revealed that the grade of tumor thrombus,morphologic types and number of neoplasms were found to be significantly associated with patients＇ survival. The multivariate Cox regression analysis demonstrated the prognostic factors associated with patients＇ survival were grade of tumor t hrombus, and number of neoplasms. Conclusion The long term survival of HCC patients with PVTT treated by liver transplantation is not satisfaction.