肝癌肝切除后的复发补救性肝移植治疗

背景：在当前供肝紧缺的情况下,补救性肝移植策略的提出为缓解这个问题提供了新的方向。目的：对比符合Milan标准肝癌患者肝切除后复发再行补救性肝移植和直接行肝移植的疗效。方法：选择2001-07/2009-08在解放军南京军区福州总院肝胆外科接受肝移植治疗,符合Milan标准的肝癌患者53例,其中12例符合Milan标准肝切除后复发再行肝移植,作为补救性肝移植组,41例行直接肝移植。结果与结论：补救性肝移植组手术时间、无肝期、术中出血量、术中悬浮红细胞输注量、ICU时间、住院总时间、住院总费用明显高于直接肝移植组(P > 0.05),两组术中冰冻血浆输注量比较差异无显著性意义(P < 0.05)。随访39个月,两组总体生存率差异无显著性意义(P > 0.05)。说明对于符合Milan标准的肝癌患者首次行肝切除,待其复发再行肝移植也是一种可行的策略。

Salvage liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy

BACKGROUND:As donor organs shortage are serious at present, salvage liver transplantation strategy offers a new way to solve the problem. OBJECTIVE:To contrast the efficacies of salvage liver transplantation for postoperative tumor recurrence and primary liver transplantation in hepatocellular carcinoma patients who meet Milan criteria.METHODS:A total of 53 hepatocellular carcinoma patients with tumor met Milan criteria who underwent liver transplantation in the Department of Hepatobiliary Surgery of Fuzhou General Hospital from July 2001 to August 2009 were included. Among them, 12 cases met the Milan criteria of postoperative tumor recurrence and received salvage liver transplantation. While 41 patients received primary liver transplantations.RESULTS AND CONCLUSION:The operation time, anhepatic phase, the volume of blood loss, suspension red blood cell transfusion during operation, ICU time, total hospitalization time, the total cost of hospitalization in salvage liver transplantation group were significantly larger than that in the primary liver transplantation group (P > 0.05). There was no significant difference in fresh frozen plasma transfusion between the two groups (P < 0.05). There was no significant difference in the overall survival rates between the two groups throughout the follow-up period of 39 months (P > 0.05). It demonstrates that liver resection prior to liver transplantation can be integrated with the treatment strategy for hepatocellular carcinoma patients with tumor meets Milan criteria.