肝癌肝移植术后骨转移患者的手术治疗

Posttransplant bone metastasis in hepatocellular carcinoma patients receiving liver transplantation

目的分析肝癌肝移植术后肝癌骨转移患者的临床特征、手术疗效及预后影响因素。方法回顾性分析2000年7月至2010年1月就诊于北京大学人民医院20例肝癌肝移植术后骨转移手术患者的临床资料，总结其临床特征，随访了患者的生存状况。与同时期未行手术治疗的患者进行对比，评价手术疗效，对可能影响患者的预后因素进行单、多因素分析。结果肝移植术后肝癌骨转移患者的中位生存时间为7．5个月，肝癌骨转移术后1年生存率仅为20％。手术治疗能够明显改善患者的疼痛和一般体力状况。单因素发现肝癌骨转移时的终末期肝病模型（modelend．stageliverdisease，MELD）评分和肝癌是否伴有微血管浸润是影响患者预后的因素。多因素分析提示，手术切除肝癌是否伴有微血管浸润是影响患者预后的危险因素。结论肝移植术后肝癌骨转移的患者预后较差，手术治疗能够提高这类患者的生活质量。肝移植时肝癌是否合并微血管浸润影响这些手术患者预后的独立危险因素。

Objective To analyze clinical features, surgical treatment efficacy and prognostic factors of bone metastasis patients after liver transplantation for hepatocellular carcinoma. Methods A retrospective clinical data of 20 bone metastasis patients after liver transplantation for hepatocellular carcinoma from July 2000 to January 2010 were received. The effect of surgery aimed at bone metastasis was evaluated. Univariate and multivariate prognostic risk factors were analyzed. Results The median survival time of these patients was 7. 5 months and 1-year survival rate was only 20%. Surgical treatment could relieve pain and promote patients＇ peformanee status significantly. Univariate and multivariate analysis found that tumor microvascular invasion within the removed recipient liver was the only prognostic risk factor. Conclusions Patients of bone metastasis after liver transplantation for HCC had poor prognosis. Surgical treatment helps improve patient＇s quality of life. Tumor microvascular invasion is the risk factor of surgical prognosis.