直接肝移植与挽救性肝移植治疗原发性肝癌疗效分析

Primary liver transplantation and salvage liver transplantation for patients with primary liver cancer

目的比较直接肝移植和挽救性肝移植治疗原发性肝癌的长期预后，分析挽救性肝移植策略的可行性。方法回顾性分析2005年6月至2015年3月天津市第一中心医院移植中心收治的1420例原发性肝癌肝移植患者的临床资料，其中挽救性肝移植患者170例，直接肝移植患者1250例。比较两组患者的生存曲线及术后1、3、5年生存率。结果直接肝移植术后1、3、5年生存率分别为77．2％、59．4％、54．6％，挽救性肝移植术后1、3、5年生存率分别为70．3％、48．1％、41．8％。两组1、3、5年生存率差异具有统计学意义（均P〈0．05）。结论挽救性肝移植组患者术后长期生存率略低于直接肝移植组，但是作为复发性肝癌的主要治疗手段之一仍是可行的。

Objective To compare long-term outcome of primary liver transplantation and salvage liver transplantation in treating patients with primary liver cancer, and discuss the clinical feasibility of salvage liver transplantation. Methods We retrospectively analyzed the clinical data of 1 420 patients with primary liver cancer, including 170 cases treated with salvage liver transplantation and 1 250 cases with direct liver transplantation from Transplantation Center of Tianjin First Center Hospital between June 2005 and March 2015. The survival curve and 1, 3, 5-year survival rates were also compared between the two groups. Results Postoperative 1, 3, 5-year survival rates were 77.2%, 59.4%, 54.6% in the primary liver transplantation group and 70.3 %, 48.1% , 41.8% in the salvage liver transplantation group, respectively. Significant statistical differences were observed （ all P 〈 0.05 ）. Conclusions Salvage liver transplantation resuited in lower long-term survival rates in salvage liver transplantation than primary liver transplantation. Nevertheless, as one of the major treatment options, salvage liver transplantation is feasible for patients with recurrent liver cancer.