活体肝移植治疗原发性肝癌的疗效分析

LIVING DONOR LIVER TRANSPLANTATION FOR ADULT PATIENTS WITH HEPATOCELLULAR CARCINOMA

目的通过活体肝移植(LDLT)与尸体肝移植(DDLT)治疗原发性肝癌(HCC)的比较,探讨LDLT治疗HCC的疗效。方法分析2007年1月至2008年12月间我院实施的105例肝癌肝移植手术(其中LDLT38例,DDLT67例)的临床资料和随访结果。结果 LDLT患者1年及3年生存率分别为92.1%及78.9%,DDLT患者1年及3年生存率分别为85.1%及73.1%。两者比较无统计学差异(P=0.5567)。LDLT患者1年及3年无瘤生存率分别为78.9%及71.1%,DDLT患者1年及3年无瘤生存率分别为76.1%及67.2%。两者比较无统计学差异(P=0.5269)。超过UCSF标准病人3年生存率与符合Mi-lan标准及UCSF标准病人的生存率有统计学差异(P<0.05)。肿瘤病理分级程度,AFP水平与肿瘤复发,病人的生存率密切相关。结论 LDLT治疗HCC可以取得同DDLT一样的效果,是治疗HCC的一项安全,有效的措施,合理适当的扩大受体选择标准可以使更多的肝癌患者受益,因而值得推广运用。

Objective To compare the outcome of living donor 1iver transplantation（LDLT） and deceased donor liver transplantation（DDLT） for adult patients with hepatocellular carcinoma（HCC）.Methods From January 2007 to December 2008,a total of 38 LDLT and 67 DDLT for HCC patients were performed in our center.The clinical and follow-up data of these 38 LDLT recipients and 67 DDLT recipients were analyzed retrospectively.Results Survival rates at 1-and 3-years for LDLT were 92.1% and 78.9% and for DDLT were 85.1% and 73.1%,respectively.The overall 1-and 3-year recurrence-free rates for LDLT were 78.9% and 71.1%,and for DDLT were 76.1% and 67.2%,respectively.No significant differences were found by the logranktest on both long-term and recurrence-free survival rates.Patients with tumors beyond the UCSF criteria had a significant difference versus the other two groups（P0.05） in 3-year survival rate.The patients＇ survival is closely related to degree of tumor grade,AFP levels and tumor recurrence.Conclusions Our present results preliminarily suggest that LDLT for the HCC patients an acceptable chance and duration of survival in patients with HCC,and it is a relatively safe procedure.