活体肝移植治疗原发性肝癌的中长期随访

摘要

Objective To evaluate the therapeutic effect and benefit achieved on patients with hepatic carcinoma after live donor liver transplantation (LDLT)based on medium- and long-term follow-up experience. Methods Patients who underwent LDLT for primary hepatic carcinoma between May 2007 and April 2011 in the Department of Liver Surgery of Ren Ji Hospital in Shanghai were enrolled into this study,the clinical pathological data,perioperative outcomes,postoperative complications and follow-up results were retrospectively reviewed from liver transplantation database. Results From May 2007 to April 2011,there were a total of 41 patients with pathologically proven primary hepatic carcinoma underwent LDLT in our center,with 35 males(85.4%) and 6 females(14.6%),mean age of 50(28-66)years. All of the patients underwent LDLT,and were diagnosed with primary liver cancer by pathology. Salvage LDLT was performed in 3 patients(7.3%),and 13 cases(31.7%)received downstaging before LDLT. 24 of them(58.5%)met the Milan criteria,and 17 case(41.5%)exceeded the criteria. Postoperative complications happened in this group of patients included postoperative infections(13 cases,31.7%),biliary complications(11 cases, 26.8%), vascular complications(1 case, 2.4%), intra-abdominal bleeding (1 case,2.4%),multiple organ dysfunction syndrome(MODS,1 case,2.4%),hypertension(1 case,2.4%),mental symptom(1 case,2.4%),wound infection(3 cases,7.3%)and wound dehiscence(1 case,2.4%). Perioperative death occurred in 1 patient(2.4%). Overall 1- and 5-year cumulative survival rates were 90.1% and 72.3%, respectively;and 1-and 5-year cumulative recurrence rates were 20.9%and 29.0%,respectively. 1-and 5-year survival rates in 24 cases meeting Milan criteria and 17 exceeding Milan criteria were 91.7%vs. 87.5%and 83.1%vs. 56.3%(P=0.051);and 1-and 5-year cumulative survival rates were 13.0%vs. 32.7%and 17.4%vs. 47.0%(P=0.035) Conclusion Patients with primary hepatic carcinoma could achieve favorable outcomes after LDLT.%目的基于单中心的中长期随访结果，探讨活体肝移植治疗原发性肝癌的疗效及优势。方法回顾性总结2007年5月至2011年4月在上海仁济医院肝脏外科行活体肝移植的原发性肝癌患者的临床资料、围手术期数据、并发症情况以及中长期随访结果。结果41例患者的乙肝表面抗原均为阳性；患者中男性35例（85.4％），女性6例（14.6％）；中位年龄50（28~66）岁；所有患者都进行活体肝移植，术后病理确诊为原发性肝癌；其中3例（7.3%）为挽救性肝移植，13例（31.7％）患者在肝移植前接受术前降期治疗；符合米兰标准的患者为24例（58.5%），17例超米兰标准（41.5％）。术后并发症包括感染13例（31.7％）、胆道并发症11例（26.8％）、血管并发症1例（2.4％）、腹腔内出血1例（2.4％）、多器官功能障碍综合征（MODS）1例（2.4％）、高血压1例（2.4％）、精神症状1例（2.4％）、切口液化3例（7.3％）和切口裂开1例（2.4％），1例患者发生围手术期死亡（2.4％）。术后1年和5年累积总生存率分别为90.1%和72.3%，1年和5年累积复发率分别为20.9%和29.0%。24例符合米兰标准与17例超米兰标准患者的1年和5年生存率分别为91.7％比87.5％和83.1％比56.3％（P＝0.051），1年和5年累积复发率分别为13.0％比32.7％和17.4％比47.0％（P＝0.035）。结论活体肝移植治疗原发性肝癌能取得良好的近远期手术疗效。