| 摘要: |
| 目的：比较原发性肝癌切除术后复发患者与初次发生肝癌患者肝移植术后生存率的差异,筛选肝移植术后病死率相关的危险因素。方法：回顾性分析2003年7月至2005年8月收治的77例原发性肝癌患者,其中15例为术后复发肿瘤患者(复发组),62例为初发肿瘤患者(对照组),比较两组患者术后生存率。对所有患者的临床数据进行分析,并通过Cox风险比例模型筛选患者移植术后生存率的影响因素。结果：患者平均年龄为(48.6±4.3)岁,术后随访(20±3.7)个月,复发组和对照组分别有3例(20%)和15例(24.2%)患者死亡,移植术后30 d内病死率分别为6.7%和1.6%。Cox风险比例模型提示,术前高胆红素、最大肿瘤直径较大、肉眼癌栓、术后输血以及肿瘤家族史是术后死亡的危险因素。结论：复发和初发肝移植患者术后生存率无显著差异;术前高胆红素、最大肿瘤直径较大、肉眼癌栓、术后输血以及肿瘤家族史是移植术后病死的危险因素。 |
| 关键词: 肝肿瘤 肝移植 肝切除术 复发 生存率 |
| DOI：10.3724/SP.J.1008.2008.00600 |
| 投稿时间：2008-03-04修订日期：2008-03-24 |
| 基金项目:上海市科委科研重大课题(024119001). |
|
| Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy |
| SHAO Zhuo,LU Jun-hua,YANG Ning,ZHANG Hai-bin,SIMA Hui,YANG Tian,YANG Guang-shun* |
| (Department of 2nd Biliary Tract Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438,China) |
| Abstract: |
| Objective：To compare post-orthotopic liver transplantation(OLT) survival rates between patients with recurrent HCC after partial hepatectomy and those with de novo OLT for HCC,and to screen for the risk factors associated with post-OLT mortality.Methods: From July 2003 to August 2005,77 consecutive HCC patients underwent OLT,including 15 patients with recurrent HCC after partial hepatectomy for tumor resection(the rescue OLT group) and 62 patients with de novo OLT for HCC(the de novo OLT group); the post-operation survival rates were compared between the 2 groups.Thirty-three demographic,clinical,histological,laboratory and intra- and post-operative variables were analyzed.Cox proportional hazards regression model were used to screen for the factors associated with the survival rate.Results: The median age of the patients was 48.6 years and the median follow-up period was 20 months.Three patients(20.0%) in the rescue OLT group and 15 patients(24.2%) in the de novo OLT group died during follow-up(P=0.73).The 30 day-mortality of OLT was 6.7% for the rescue OLT group vs.1.6% for the de novo OLT group(P=0.27).Cox proportional hazards model showed that the presence of pre-OLT hyperbilirubinemia,requirement of post-OLT transfusion,size of the largest tumor,tumor macroembolism and family history of HCC were significantly associated with a higher hazard for mortality.Conclusion: No significant difference is found in the survival rates between OLT as de novo therapy and OLT as a rescue therapy for patients with HCC.Pre-OLT hyperbilirubinemia,post-OLT requirement of transfusion,size of the largest tumor,tumor macroembolism,and family history of HCC are associated with a poor survival outcome. |
| Key words: liver neoplasms liver transplantation hepatectomy recurrence survival rate |
