肝移植治疗原发性肝癌

目的探讨我国肝移植治疗原发性肝癌的手术适应证及效果。方法回顾性分析我院1999年2月至2004年连续施行的170例原位肝移植手术，对其中原发性肝癌62例的临床分期，手术方式及术后长期生存情况等进行分析，探讨手术指征及效果。结果62例肝癌肝移植病人，随访1～39个月，住院期间死亡4例（6．45％），存活病例1、2、3年肿瘤复发转移率分别为29．31％，41．38％，58．06％；1、2、3年生存率分别为87．45%，65．59％，42．06％，进一步分析发现肿瘤直径〈5cm者6例，全部无瘤生存；肿瘤伴门静脉主干癌栓者7例，除1例无瘤生存1年2个月外余均于1年内复发或死亡。结论晚期肝癌尚无门静脉主干癌栓者可作为我国肝移植指征，应进一步探索围手术期防治肝癌复发转移措施，进一步提高我国肝癌肝移植的疗效。

Treatment of primary liver cancer by orthotopic liver transplantation

Objective To determine the clinical indications and results in patients with primary liver cancer (PLC) for orthotopic liver transplantation (OLT). Methods The clinical data of 170 patients receiving OLT from February 1999 to April 2004 in our hospital were retrospectively analyzed. Amongst the 170 patients, 62 were with PLC. The clinical staging, surgical approach and long-term survival rate were analyzed in the 62 patients to explore the reasons for success and failure. Results Of the 62 patients, 4 died during hospitalization (mortality=6.45%). The follow-up study for 1-39 months showed that the 1-, 2- and 3-year recurrence rates were 29.31%, 41.38% and 58.06%, and the 1-, 2- and 3-year survival rates 87.45%, 65.59% and 42.06%, respectively. Further study revealed that all the 6 patients with tumor diameter less than 5 cm were alive but all the 7 patients (except 1) with portal vein cancer thrombosis had recurrence or died. Conclusions The PLC without portal vein cancer thrombosis can be the indication of OLT in our country. Perioperative prevention method for recurrence of liver cancer should be explored for raising survival rate in the patients with PLC after OLT.