补救性肝移植的疗效

目的探讨补救陛肝移植的适应证及其临床疗效。方法回顾性分析2003年10月至2006年3月中山大学附属第三医院35例肝癌肝切除术后行肝移植患者的临床资料。比较补救性肝移植组（19例）和超补救性肝移植组（16例）患者的手术情况、术后并发症及预后等指标。计数和计量资料分别采用X^2和t检验，非正态分布采用秩和检验，Kaplan-Meier法进行生存分析，生存率的比较采用Log-rank检验。结果补救性肝移植组和超补救性肝移植组患者的无肝期、冷缺血时间、手术时间、术中出血量、术中输注红细胞量、术中输注新鲜冰冻血浆量、肝移植并发症发生率、再移植率分别为（32±9）rain、（8．0±2．1）h、（7．6±1．5）h、2300ml、8U、23U、6／19、2／19和（34±7）min、（7．4±2．3）h、（7．4±2．0）h、2750ml、12U、20U、4／16、1／16，两组比较，差异无统计学意义（t=0．726，-0．804，-0．366，Z=-0．348，-0．549，-0．149，）（X^2=0．184，0．203，P〉0．05）。补救性肝移植组和超补救性肝移植组患者围术期死亡率、术后肿瘤复发率分别为0、2／19和4／16、9／16，两组比较，差异有统计学意义（X^2=5．363，8．426，P〈0．05）。补救性肝移植组和超补救性肝移植组患者1、3、5年累积生存率分别为100％、84％、84％和75％、33％、33％；1、3、5年无瘤生存率分别为100％、89％、89％和48％、29％、19％，两组比较，差异有统计学意义（X^2=11．58，19．31，P〈0．05）。结论补救性肝移植是肝癌治疗过程中的一种有效策略，米兰标准是目前补救性肝移植的最佳适应证。

Efficacy of salvage liver transplantation for patients with hepatocellular carcinoma after liver resection

Objective To evaluate the efficacy and indications of salvage liver transplantation for patients with recurrent hepatocellular carcinoma （ HCC ） after liver resection. Methods The clinical data of 35 HCC patients who received salvage liver transplantation after liver resection at the Third Affiliated Hospital of Sun Yat-sen University from October 2003 to March 2006 were retrospectively analyzed. All patients were divided into the salvage liver transplantation （SLT） group （ n = 19） and extended SLT group （ n = 16）. Perioperative condition, postoperative complications and prognosis of the 2 groups were compared. The survival rate was analyzed and com-pared by the Kaplan-Meier method and Log-rank test, respectively. Results The anhepatic phase, ischaemic time, operation time, intraoperative blood loss, packed red blood cell transfusion, fresh frozen plasms transfusion, mobidity and retransplantation rate were （32 ± 9） minutes, （ 8.0 ± 2.1 ） hours, （7.6 ± 1.5 ） hours, 2300 ml, 8 U, 23 U, 6/19 and 2/19 in the SLT group, and （34 ± 7） minutes, （7.4 ± 2.3） hours, （7.4 ± 2.0） hours, 2750 ml, 12 U, 20 U, 4/16, 1/16 in the extended SLT group, respectively, with no significant difference between the 2 groups （t=0.726, -0.804, -0.366, Z= -0.348, -0.549, -0.149, X2 =0.184, 0.203, P〉0.05）. The perioperative mortality, tumor recurrence rate were 0 and 2/19 in the SLT group, and 4/16 and 9/16 in the extended SLT group, with significant differences between the 2 groups （ X^2 = 5. 363, 8. 426, P 〈 0.05）. The 1-, 3-, 5-year cumulative survival rates were 100%, 84% and 84% in the SLT group, and 75% , 33% and 33% in the extended SLT group. The 1-, 3-, 5-year tumor-free survival rates were 100%, 89% and 89% in the SLT group, and 48%, 29% and 19% in the extended SLT group. There were significant differences in the cumulative and tumor-free survival rates between the 2 groups （X^2 = 11.58, 19.31, P 〈 0.05）. Conclusions The efficacy of SLT is satisfactorv in the treatment of recurrent HCC. The ontimal indication for SLT is Milan criterin.