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目的探讨肝癌肝移植 Milan 标准的临床应用价值和注意事项。方法回顾性分析2001年12月至2005年11月术前 CT 检查符合 Milan 标准的125例肝细胞癌行肝移植患者的临床资料,对比影像学与病理学检查结果的差别及其对患者生存时间的影响。结果 125例患者中,切除肝脏病理检查证实符合 Milan 标准者97例,超出 Milan 标准者26例,2例未发现癌灶最终诊断为结节状肝硬化,准确率为77.6%。影像学与病理学符合 Milan 标准的肝移植患者的1、2、3、4和5年生存率分别为92.0%和92.8%、87.2%和90.7%、86.4%和89.7%、86.4%和89.7%、86.4%和89.7%,两组间生存率无明显差别(P>0.05)。病理学上超出 Milan 标准的患者1、2、3、4和5年生存率分别为73.0%、65.4%、61.5%、61.5%和61.5%,与病理学符合及影像学检查符合组间均存在明显差异(P<0.05)。结论术前螺旋 CT 诊断符合 Milan 标准的肝细胞癌患者肝移植术后生存良好,但应进一步提高诸如门静脉主要分支癌栓、淋巴结转移等导致病期误判因素的诊断水平。
Objective To investigate the clinical value and precautions of Milan standard liver transplantation for liver cancer. Methods The clinical data of 125 patients with hepatocellular carcinoma undergoing liver transplantation undergoing preoperative CT examinations from December 2001 to November 2005 in our hospital were retrospectively analyzed. The difference between radiographic and pathological findings and their effect on survival time Impact. Results Of the 125 patients, 97 patients with Milan criteria were confirmed by pathological examination of liver biopsy, 26 patients were beyond the standard of Milan, and 2 patients were diagnosed as nodular cirrhosis without final diagnosis. The accuracy was 77.6%. The 1, 2, 3, 4 and 5-year survival rates of liver transplant patients who met Milan criteria for imaging and pathology were 92.0% and 92.8%, 87.2% and 90.7%, 86.4% and 89.7%, 86.4% and 89.7%, respectively , 86.4% and 89.7% respectively, there was no significant difference between the two groups (P> 0.05). The 1, 2, 3, 4 and 5-year survival rates of the patients who pathologically exceeded the Milan criteria were 73.0%, 65.4%, 61.5%, 61.5% and 61.5%, respectively, which were consistent with pathological findings and imaging findings Significant difference (P <0.05). Conclusions Preoperative helical CT diagnosis of hepatocellular carcinoma in line with Milan standards in patients with liver transplantation after good survival, but should be further improved, such as the main portal vein tumor thrombus, lymph node metastasis leading to the diagnosis of miscarriage of life factors.