肝癌肝移植围手术期死亡10例分析

Death data of patients with hepatocellular carcinoma after liver resection in the perioperative period of liver transplantation: an analysis of 10 cases

目的分析肝癌肝移植围手术期死亡的原因,总结肝癌切除术后行肝移植的临床经验。方法回顾性分析2003年10月至2008年10月中山大学附属第三医院肝移植中心81例肝癌肝移植的临床资料,对其中10例围手术期(≤30d)死亡原因进行分析。结果肝癌切除术后病人肝移植总病死率为12.3%(10/81)。首次肝切除术后肝移植病死率为12.7%(9/71);再次肝癌肝移植病死率为10%(1/10)。补救性肝移植病死率为10%(4/40),超越补救性肝移植病死率16.1%(5/31)。肺部感染(6例)和术中腹腔大出血(5例)是围手术期的主要死亡原因。手术相关死亡5/10,5例术中腹腔出血量均>10000mL。结论肝癌肝移植围手术期病死率仍较高;肺部感染和术中腹腔大出血是围手术期的主要死亡原因。

Objective To analyze death data of patients with hepatocellular carcinoma after liver resection in the perioperative period of liver transplantation（LT） so as to summary the clinical experience. Methods The clinical data of 81 liver transplant recipients with hepatocellular carcinoma after liver resection from October 2003 to October 2008 in the Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The death data of 10 patients in the perioperative period of LT were analyzed. Results The overall mortality of liver transplant recipients with hepatocellular carcinoma after liver resection was 12.3% （10/81）. The mortality of patients with hepatoeellular carcinoma after liver resection for primary LT （ ≤ 30d）was 12.7% （9/71）. The mortality of patients with hepatocellular carcinoma after repeated liver resection for LT （ ≤ 30d ） was 10% （1 / 10）. The mortality of patients for salvage LT （ ≤30d ） was 10% （ 4/ 40）. The mortality of patients beyond salvage LT （≤30d） was 16.1% （5/31）. Pulmonary infection （6/10） and intraoperative massive abdominal bleeding （5/10） were major causes of death in the perioperative period of liver transplantation. The surgical related mortality in the perioperative period of liver transplantation was 5/10. The volume of five patients with intraoperative massive abdominal bleeding was more than 10 000 mL. Conclusion The mortality of liver transplant recipients with hepatocellular carcinoma after liver resection remains higher. Pulmonary infection and intraoperative massive abdominal bleeding are the main death causes for patients who underwent liver transplantation after liver resection for HCC.