Analysis on curative effect of salvage liver transplantation on patients with recurrence after hepatocellular carcinoma resection
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摘要:
目的 初步探讨采用补救性肝移植(SLT)治疗肝切除术后复发性原发性肝癌(肝癌)的临床效果。 方法 回顾性分析2005年4月至2012年12月在西安交通大学医学院第一附属医院连续施行的68例肝癌肝移植患者的临床资料。其中60例患者行首选肝移植(PLT),即PLT组;8例患者行SLT,即SLT组。比较两组患者的手术时间、无肝期时间、术中出血和输血量;比较两组患者重症监护室(ICU)入住时间和总住院时间;比较两组患者术后并发症发生情况。根据两组患者的随访结果绘制Kaplan-Meier生存曲线,采用Log-rank检验比较两组患者累积生存率和无瘤生存率。 结果 SLT组患者的手术时间、无肝期时间、术中出血量及输血量均明显长于或多于PLT组(均为P<0.05),两组的ICU入住时间和总住院时间比较,差异均无统计学意义(均为P>0.05)。两组术后出血、感染、急性排斥反应、肾衰竭及胆道并发症发生率比较,差异均无统计学意义(均为P>0.05)。随访时间1~90个月,平均随访时间为33个月。SLT组术后的1、2、3年累积生存率分别为87.5%、75.0%、62.5%,PLT组分别为80.0%、73.8%、67.8%,两组Kaplan-Meier生存分析比较差异无统计学意义(P>0.05)。SLT组术后1、2、3年无瘤生存率分别为75.0%、62.5%、50.0%,PLT组分别为81.2%、68.6%、64.6%,两组Kaplan-Meier生存分析比较差异亦无统计学意义(P>0.05)。 结论 SLT治疗肝癌切除术后肝内复发疗效较好,在供体短缺的情况下选择实施补救性肝移植不失为一种有效可行的治疗策略。 Abstract:Objective To explore the clinical efficacy of salvage liver transplantation(SLT) for hepatocellular carcinoma recurrence after hepatocellular carcinoma resection. Methods Clinical data of 68 patients who underwent liver transplantation treating for hepatocellular carcinoma from April 2005 to December 2012 in the First Affiliated Hospital of Xi'an Jiaotong University were analyzed retrospectively. Among them, 60 patients underwent primary liver transplantation(PLT, PLT group), and 8 patients underwent SLT for recurrence (SLT group). Intraoperative situation was compared between two groups including operation time, time of anhepatic phase, volume of blood loss and blood transfusion. Time in intensive care unit(ICU) and total length of hospital stay were compared between two groups. The occurrence of postoperative complication was compared between two groups. And the survival curves were drawn by the Kaplan-Meier method according to the follow-up result between two groups. Cumulative survival rate and tumor free survival rate were compared by log-rank tests between two groups. Results The operation time, anhepatic time, volume of blood loss and blood transfusion of patients in SLT group were higher than those in PLT group(all in P<0.05). There was no significant difference in the time in ICU and total length of hospital stay between two groups(all in P>0.05). There was no significant difference in the occurrence of bleeding, infection, acute rejection, renal failure and biliary complication between two groups(all in P>0.05). All the patients were followed up for 1-90 months with the average of 33 months. The cumulative survival rates of 1, 2 and 3 years were 87.5%, 75.0%, 62.5% in SLT group and 80.0%, 73.8%, 67.8% in PLT group respectively, and there was no significant difference by Kaplan-Meier analysis between two groups(P>0.05). And the tumor free survival rates of 1, 2 and 3 years were 75.0%, 62.5%, 50.0% in SLT group and 81.2%、68.6%、64.6% in PLT group, and there was no significant difference by Kaplan-Meier analysis between two groups either(P>0.05). Conclusions SLT has a good curative effect on the treatment of hepatocellular carcinoma recurrence after hepatocellular carcinoma resection. In the era of organ shortage,SLT is a effective treatment strategy. -
图 1 两组患者累积生存率与无瘤生存率比较
Figure 1. Comparison of cumulative survival rate and disease free survival rate of patients between two groups
表 1 补救性肝移植组患者移植前肿瘤病理资料
Table 1. Pathological data of tumor of patients in salvage liver transplantation group before transplantation
序号 复发肿瘤大小(cm×cm) 肿瘤数目(个) 复发肿瘤分化程度 微血管浸润 Milan标准 UCSF标准 例1 1.5×1.0 >3 低分化 无 超出 超出 例2 9.0×8.0 3 中分化 有 超出 超出 例3 3.0×3.0 >3 中分化 有 超出 超出 例4 6.5×3.0 1 低分化 有 超出 符合 例5 4.5×4.5 3 中分化 无 超出 符合 例6 1.5×1.0 1 中分化 无 符合 符合 例7 1.8×1.5 3 低分化 无 符合 符合 例8 5.0×3.5 1 高分化 无 符合 符合 
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表 2 两组患者术中情况的比较
Table 2. Comparison of intraoperative situation of patients between two groups(x±s)
组 别 n 手术时间(h) 无肝期(min) 出血量(ml) 输血量(ml) ICU入住时间(d) 住院时间(d) PLT组 60 7.2±1.8 45±12 810±211 1 018±423 8.5±2.0 36±20 SLT组 8 8.6±2.5 57±10 1 975±215 2 675±234 8.6±2.5 42±23 P值 ＜0.05 ＜0.05 ＜0.05 ＜0.05 >0.05 >0.05
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表 3 两组患者术后并发症发生情况的比较
Table 3. Comparison of postoperative complications of patients between two groups [n(%)]
组 别 n 出血 感染 急性排斥反应 肾衰竭 胆道并发症 PLT组 60 2(3) 1(2) 5(8) 2(3) 8(13) SLT组 8 0 1(13) 3(38) 0 1(13)
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