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目的评估肝癌患者肝癌切除术后肝癌复发行补救性肝移植术的临床治疗效果及预后影响因素。方法回顾性分析本治疗组自2000年4月至2008年6月间实施的88例肝癌切除术后复发行补救性肝移植术病例,分析该组病例手术特征、生存状况、病理因素对预后影响。结果肝癌切除术后复发行补救性肝移植病例平均年龄为52.4±9.2岁(26.8～74.3岁),中位随访时间32.9个月,平均术程为10.76±3.05小时,平均出血量为3254.6±2809.3ml;本组病例行补救性肝移植术后6月、1年、3年、5年累计生存率为85.0%,70.8%,51.3%,44.7%;符合米兰标准17例,超出米兰标准70例,两组生存率比较无明显统计学差异(P(0.295)>0.05);肿瘤新Edmondson评级、肿瘤TNM分期,以及有无肝静脉、门静脉侵犯对预后存在显著影响。结论肝癌切除术后复发行补救性肝移植并不明显增加手术风险和降低生存率;在器官短缺的时代,补救性肝移植对于肝癌切除术后复发患者是有效可行的治疗策略。
Objective To evaluate the clinical effects and prognostic factors of recurrent hepatocellular carcinoma after liver resection in patients with liver cancer. Methods A retrospective analysis of the treatment group from April 2000 to June 2008 88 cases of resection of liver cancer resection of the case of reclaimed liver transplantation, analysis of the surgical characteristics of the group, survival conditions, pathological factors on the prognosis . Results The average age of patients who underwent resected liver transplantation after resection of liver cancer was 52.4 ± 9.2 years (range, 26.8-74.3 years). The median follow-up time was 32.9 months with an average course of 10.76 ± 3.05 hours and an average blood loss of 3254.6 ± 2809.3 ml; The 5-year cumulative survival rates of patients who underwent salvage liver transplantation in this group were 85.0%, 70.8%, 51.3% and 44.7% at 6 months, 1 year, 3 years and 5 years respectively. There was no significant difference between the two groups (P (0.295)> 0.05). The new Edmondson grade, tumor TNM stage, presence or absence of hepatic vein and portal vein invasion had significant effect on prognosis. Conclusions Recurrence of liver transplantation after resection of liver cancer does not significantly increase the risk of surgery and reduce the survival rate. In the era of organ shortage, resection of liver transplantation for resection of liver cancer patients after resection is an effective and feasible treatment strategy.