活体肝移植治疗原发性肝癌的价值与风险评价

目的评价活体肝移植治疗原发性肝癌的价值与风险。方法自2002年1月至2006年12月，四川大学华西医院肝脏移植中心对27例原发性肝癌患者实施活体肝移植治疗，其中25例接受右半肝移植物，2例接受双供体移植物；对这27例受体及其29例供体的临床资料和随访结果进行回顾性分析。结果本组供体无死亡发生，并发症发生率为17．24％（5例），其中2例（6．90％）发生较严重的并发症，包括腹腔内出血及门静脉栓塞各l例；3例（10．34％）并发症较轻，伤口脂肪液化并感染、胸腔积液及乳糜漏各l例；所有供体目前都已完全康复，并回到以前的工作岗位。本组受体无一例发生小肝综合征，全组病例1年及3年累积生存率分别为84．01％及71．40％，与同期因各种其他非恶性疾病进行的成人活体肝移植受体1年及3年累积生存率（83．30％及75．51％）比较，两者差异无统计学意义（P〉0．05）。结论虽然活体肝移植治疗原发性肝癌对供体的风险及受体的益处尚需进一步的研究评价，但研究结果已初步表明，只要我们努力作好每一个细节，活体肝移植对供体来说是一相对安全的手术；而对肝癌患者来说则能相对满意地延长生存期，值得进一步推广运用。

Evaluation of living donor liver transplantation for patients with hepatocellular carcinoma

OBJECTIVE: To evaluate the donor risks and potential recipient benefits of living donor liver transplantation (LDLT) for adult patients with hepatocellular carcinoma (HCC). METHODS: From January 2002 to December 2006, a total of 27 LDLT for HCC patients were performed in our center, of which 25 received right lobe grafts and 2 received dual grafts. The clinical and follow-up data of these 27 recipients and 29 donors were analyzed retrospectively. RESULTS: Of the 29 donors, the overall complication rate was 17.24% (5 cases). Two cases (6.90%) experienced major complications (one with intra-abdominal bleeding and one with portal vein thrombosis) and three cases (10.34%) experienced minor ones (fat necrosis and infection of the surgical skin wound in one, pleural effusion in another and transient chyle leakage in the third). All donors were fully recovered and returned to their previous work. No recipients developed small-for-size syndrome. The overall HCC patients survival rate at 1- and 3-years was 84.01% and 71.40%, respectively, similar to that of patients undergoing LDLT for various nonmalignant diseases during the same period (P > 0.05). CONCLUSION: Although further study is needed to fully assess the risks and benefits of LDLT for the HCC patients and donors, our present results preliminarily suggest that LDLT offers an acceptable chance and duration of survival in patients with HCC, and it is a relatively safe procedure.