肝门部胆管癌行肝移植术7例

Liver transplantation for hilar cholangiocarcinoma: Analysis of 7 cases

目的:报道7例不可手术切除的肝门部胆管癌患者行肝移植术,结合文献对其临床预后因素、临床结果进行分析.方法:回顾性调查研究分析2000-03/2010-12中国人民解放军海军总医院7例肝门部胆管癌行肝移植患者的临床资料,分析总结其临床病理特征、术后生存时间、肿瘤复发以及预后因素.结果:7例患者术前评估均不能达到根治性切除,均行肝移植术,术后病理诊断明确,无围手术期死亡,淋巴结转移者为57.1%(4/7),2例术前CA19-9>100 KU/L.随访时间为7-108 mo,7例均死亡,肿瘤特异性死亡者5例,其中淋巴结阴性者[国际抗癌联盟(Union for International Cancer Control,UICC)分期均为2期]生存时间分别为108、37 mo,淋巴结阳性者(UICC分期,2例3b期,1例4a期)则分别为11、26、7 mo;而肿瘤非特异性死亡者2例,生存时间分别为18、34 mo.结论:对于不能外科手术切除且无淋巴结转移的肝门部胆管癌患者行肝移植术是一种有效的治疗手段.

AIM： To report seven cases of patients with unresectable hilar cholangiocarcinoma who underwent liver transplantation and to analyze prognostic factors and clinical outcome through a literature review. METHODS： The clinical data for seven patients with unresectable hilar cholangiocarcinoma who underwent liver transplantation were retrospectively analyzed. The clinicopathological features, tumor recurrence, postoperative survival and prognostic-related factors are discussed. RESULTS： Hilar cholangiocarcinoma was confirmed by histopathology postoperatively in all patients, and no perioperative deaths occurred. Lymph node metastases were found in three patients （3/7）, and preoperative CA19-9 〉 100 KU/L was found in two cases. During a 108-month follow-up period, all patients died. Of 5 patients who died of tumor recurrence, the survival time was 108 and 37 mo in two lymph node-negative patients [both had Union for International Cancer Control （UICC） stage II disease], and 11, 26 and 7 mo in the three with lymph node metastases （UICC stage IIIb in 2 patients, and IVa in 1）. The survive time for the 2 patients dying from other causes was 18 and 34 mo. CONCLUSION： Liver transplantation may be an effective treatment strategy for lymph node-negative patients with unresectable hilar cholangiocarcinoma.