合并门静脉血栓形成的肝细胞癌肝移植12例分析

目的探讨合并门静脉血栓形成(PVT)的肝细胞癌肝移植手术疗效、手术技巧及围手术期处理。方法回顾性分析中山大学附属第三医院自2003年10月至2005年6月12例合并PVT的肝细胞癌肝移植临床及随访情况。结果术后随访8d至36个月,中位时间19.5个月。术后第12天、第21天、第30天各死亡1例,死于肺部感染、多器官功能衰竭。随访期间死亡1例(术后第15个月死于肝癌复发)。目前存活8例,其中7例已经无瘤生存13、14、24、24、25、28、30个月,1例带瘤存活36个月。12例病人1年累积存活率75.0%。1例病人肝移植术后2个月吻合口局部PVT复发,目前已经存活30个月。结论合并PVT的肝细胞癌肝移植者预后良好,合理的手术技巧和恰当的术后处理可以避免术后PVT复发。

Liver transplantation for hepatocellular carcinoma combined with portal vein thrombosis: an analysis of 12 cases

Objective To investigate the therapeutic effect,operation technique and perioperative management of liver transplantation for hepatocellular carcinoma combined with portal vein thrombosis(PVT).Methods The clinical and follow-up data of 12 patients with hepatocellular carcinoma combined with portal vein thrombosis underwent liver transplantation between October 2003 and June 2005 in the Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.Results All the patients were followed up from 8 days to 36 months with median time of 19.5 months after operation. Three patients died of pulmonary infection and multiple organ failure on the 12th,21th,30th postoperative day.During the follow-up period one patients died of tumor recurrence on the 15th months after operation.In present 8 patients survived:one patient with tumor recurrence survived for 36 months after operations.The remaining 7 patients survived without tumor recurrence for 13,14,24,24,25,28,30 months.The 1-year accumulative survival rate of 12 patients was 75.0%.One patient had survived for 30 months with local PVT recurrence in 2 months.Conclusion The prognosis of patients with hepatocellular carcinoma combined with portal vein thrombosis performed liver transplantation is good. Reasonable operation technique and correct postoperation treatment can avoid the recurrence of PVT.