肝癌患者接受肝移植的价值评估

Evaluation of liver transplantation for patients with various stages of liver carcinoma

目的 探讨肝癌患者接受肝移植治疗的价值。方法 对 5 0例肝癌患者施行肝移植 ,根据肿瘤的大小、数量和侵犯范围将肝癌分为三期 ,统计分析不同期患者肝移植后的存活率及医疗费用。结果 Ⅰ期患者共 4例 ,术后存活时间均超过 1年 ,最长者已达 3年 ,其半年医疗费用为 (2 1.6 8± 1.0 8)万元 ;Ⅱ期患者共 32例 ,有 7例存活时间超过 1年 ,6个月存活率为 6 8.8% ,半年医疗费用为(2 5 .2 2± 2 .6 0 )万元 ;Ⅲ期患者共 14例 ,仅 1例存活达 12个月 ,平均存活时间 4 .1个月 ,医疗费用为(2 8.4 5± 1.34)万元。结论 综合考虑治疗效果及医疗费用 ,Ⅰ期和Ⅱ期肝癌患者可接受肝移植治疗 ,而Ⅲ期肝癌患者由于肝移植的效果差 ,费用昂贵 ,不宜提倡。

Objective To evaluate liver transplantation for patients with various stages of liver carcinoma through analyzing the survival rate and cost of half-year.Methods From January 1999 to June 2002, a total of 138 cases were subjected to orthotopic liver transplantation (OLT) in our center. Among them, there were 50 cases ( 36.2?% ) of liver carcinoma with HBV cirrhosis, which were divided into three stages (Ⅰ, Ⅱ, Ⅲ) based on the tumor pathology. SPSS 11.5 software was used to evaluate the value of liver transplantation to three stages. Results All 4 cases of stage Ⅰ were survival, and the longest has survived for 3 years. The average cost of half year was 216.8 thousand RMB. The survival rate of half year in stage Ⅱ was 68.8?% , and 7 cases survived over 1 year. Their average cost of half year was 252.2 thousand RMB. While the average survival time of stage Ⅲ was 4.1 months, and the cost ( 284.5 thousand RMB) was significantly higher than stage Ⅰ. Conclusion The patients of stage Ⅰ had a higher survival rate. The quality of life was improved in Ⅱ stage patients, and life was lengthened obviously. But it should be limited to perform in the advanced liver cancer (Ⅲ stage).