原发性肝癌与非肝癌病人行肝移植治疗的比较研究

Comparison of orthotopic liver transplantation for patients with hepatocellular carcinoma and those without liver tumor

目的 :探讨我国目前肝癌与非肝癌病人行肝移植治疗的风险及长期生存效果。方法 :回顾性总结2 1例晚期肝癌病人行肝移植手术治疗风险及长期生存情况 ,并与同期所行另外 19例非肝癌病人的肝移植进行比较。结果 :晚期肝癌病人的手术前凝血状态好于因其它非肝癌原因而接受肝移植的病人 ,与此相应的手术中出血量、需要输血量、术中输液总量均少于非肝癌病人 ,手术中因出血而导致的低血压时间短 ,手术后较恢复顺利 ,围手术期病死率低。虽然肿瘤复发所致的远期死亡率明显高于非肝癌病人 ,但是 ,总生存率与非肝癌病人无明显区别 ,部分病人可长期无瘤生存。结论 :现阶段肝移植仍是失去根治性切除机会的肝癌病人的有效治疗手段 。

Objective:To investigate the risk and prognosis of orthotopic liver transplantation (OLT)for patients with advanced hepatocellular carcinoma(HCC)and those without liver tumor.Methods:The risk and prognosis of 21 cases of orthotopic liver transplantation for patients with HCC were retrospectively reviewed and the comparison was made between such patients and 19 others with non tumor caused end stage failures whose OLT procedures have been done at the same period.Results:Compared with the non tumor OLT recipients,the HCC patients have a better preoperative coagulation function.In accordance with this,the blood lose,the required transfusion and the total infusion during the operation were also less than those of non tumor OLT patients.The duration of hypotension induced by bleeding in HCC patients were also shorter than that in non tumor patients.There were more patients in HCC group with uneventful postoperative course than that in non tumor group.The perioperative mortality was also lower in HCC group.Although the recurrence of malignance affected the long term survival of HCC patients,the whole survival rate was similar to that of non tumor OLT patients.Conclusion:OLT remains an effective alternative for the advanced HCC patients for whom there was no other better choice.It is possible that some patients can get a long term survival and are free of the recurrence of the HCC after OLT treatment.