肝脏移植对23例肝细胞性肝癌的治疗价值研究

Liver transplantation for 23 patients with hepatocellular carcinoma

目的进一步探讨肝细胞性肝癌肝移植治疗的疗效 ,评价其应用价值。方法对 1999年 2月～ 2 0 0 2年 3月连续实施的 95例肝移植中的 2 3例肝细胞肝癌患者进行随访和回顾性分析 ,探讨肝细胞性肝癌临床病理学因素对肝移植术后生存率和肝癌复发的影响。结果本组肝细胞性肝癌总的复发率为 6 5 % (15 /2 3) ,6个月、12个月的无癌生存率分别为 75 %、5 8%。多元分析表明 ,肝细胞性肝癌的直径与它的复发率有相关性 (P =0 0 2 4 ) ,而其他的临床病理学因素未显示有统计学意义(Wald =5 113,P =0 0 2 4 )。而年龄、性别、癌灶数目、门静脉癌栓形成、TNM分期、术前AFP水平、术前治疗、合并肝硬化等病理学因素则在统计学上未显示有显著意义 (P >0 0 5 )。结论大肝癌是肝移植的相对禁忌证 。

Objective To evaluate liver transplantation for patients with hepatocellular carcinoma (HCC).Methods From Feb,1999 to Mar,2002 a total of 95 cases underwent liver transplantation(LTX) in our centre, among them there were 23 cases of HCC.SPSS 10 0 software was used to evaluate the risk factors on the tumor recurrence after LTX.Results The tumor recurrence rate was 65% during the period of follow up. The patients' tumor free survival rate at 6 and 12 months was 75 0% and 58 3%, respectively. Multi variants analysis revealed that there was a statistical relationship between pretransplant tumor size and tumor recurrence( P =0 024).Statistical relations between preoperative demograplaic, clinical features and post LTX recurrence were not found.Conclusion Large hepatocellular carcinoma is a relative contraindication for LTX.