肝切除后再行肝移植与直接行肝移植治疗肝癌的比较

Surgery for hepatocellular carcinoma： salvage liver transplantation versus primary liver transplantation

目的比较肝切除后再行补救性肝移植与直接行肝移植治疗肝癌的效果及优缺点。方法检索Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库以及万方数据库中关于直接行肝移植与肝切除后补救性肝移植治疗肝癌的随机和非随机对照研究的文献。共纳入10篇回顾性研究，1115例病例，其中肝切除后补救性肝移植164例，直接肝移植951例。结果大部分研究中患者的年龄、性别及肝硬化程度等情况无明显差异。有部分研究对比了两组间肿瘤的病理特性，肿瘤大小和数目无明显差异。仅少数研究比较了两组病例中病理下微血管侵犯的差异。大部分研究表明，与直接行肝移植相比，肝切除后补救性肝移植的术中出血量及手术时间并未明显增加，术后总存活率无明显差异，无瘤存活率相似。结论相对于直接肝移植，补救性肝移植在手术时间及相关风险方面无明显增加，总存活率方面两者相似。肝癌肝切除术后补救性肝移植可以作为治疗肝癌的重要策略，尤其是早期肝癌。

Objective To compare the effectiveness and advantage of salvage liver transplantation post-resection with primary liver transplantation for HCC patients. Methods Medline, Embase, Cochrane, CBMdisc, CNKI and Wanfang Database were searched. Randomized and nonrandomized controlled trials comparing primary liver transplantation with salvage liver transplantation were analyzed. Ten retrospective studies involving 1115 patients were included. 164 received salvage liver transplantation, and 951 patients received primary liver transplantation. Results In most researches, the two groups of patients were similar for age, sex, and cirrhosis severity at time of transplantation. Some researches showed no difference in tumor size and number between the two groups. Few studies referred to microvascular invasion. Most of the researches showed there was no significant difference in blood loss, operative time, overall survival and disease-free survival between the two groups. Conclusion Compared to primary liver transplantation, salvage liver transplantation after liver resection is associated with similar operative time, risks and overall survival. Resection first and salvage liver transplantation for recurrent tumors or liver failure seem to be a feasible treatment strategy for hepatocelluar carcinoma,especially in early stage.