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目的探讨挽救性肝移植(SLT)的手术安全性及对患者预后的影响。方法回顾性分析复旦大学附属中山医院肝外科2001年6月至2008年12月期间连续289例肝癌肝移植(符合UCSF标准)患者的临床资料,其中242例患者行初始肝移植(PLT),即PLT组,47例患者行SLT,即SLT组,比较2组患者围手术期及长期生存情况的差异。结果 2组患者的平均年龄、性别构成及肿瘤情况差异均无统计学意义(P>0.05)。SLT组的手术时间要长于PLT组〔(7.1±1.8)h比(6.4±1.4)h,P=0.004〕,但2组患者的术中出血量〔(2 560.5±2 683.6)ml比(2 042.9±2 006.2)ml,P=0.173〕及术中输血量〔(13.8±12.9)U比(9.9±12.6)U,P=0.087〕比较差异均无统计学意义。SLT组患者从第1次手术切除至行肝移植的间隔时间为(32.8±32.4)个月。截至2009年12月,2组患者中位随访时间为38.7个月,SLT组与PLT组患者的3年生存率(82.3%比75.5%,P=0.312)和3年无瘤生存率(78.8%比70.1%,P=0.755)之间比较差异均无统计学意义。但按意向性治疗分析,SLT组患者的3年生存率明显优于PLT组(88.4%比76.2%,P=0.047)。结论 SLT并不增加移植手术的风险,也不影响患者的长期预后,对部分病例,先行手术切除再行肝移植可作为肝癌治疗的一种有效策略。
Objective To investigate the operative safety of salvaged liver transplantation (SLT) and its effect on the prognosis of patients. Methods The clinical data of 289 consecutive patients with hepatocellular carcinoma (UCSF) who underwent liver transplantation from June 2001 to December 2008 in Zhongshan Hospital of Fudan University were analyzed retrospectively. Among them, 242 patients underwent initial liver transplantation (PLT) In the PLT group, 47 patients underwent SLT or SLT. The difference of perioperative and long-term survival between the two groups was compared. Results The average age, sex composition and tumor status of the two groups had no significant difference (P> 0.05). The operative time of SLT group was longer than that of PLT group (7.1 ± 1.8 h vs. 6.4 ± 1.4 h, P = 0.004), but the intraoperative blood loss (2 560.5 ± 2 683.6) ml 042.9 ± 2 006.2) ml, P = 0.173], and intraoperative blood transfusion 〔(13.8 ± 12.9) U than (9.9 ± 12.6) U, P = 0.087〕 showed no significant difference. The interval between the first surgical resection and the liver transplantation in the SLT group was (32.8 ± 32.4) months. As of December 2009, the median follow-up time was 38.7 months in both groups. The 3-year survival rates (82.3% vs. 75.5%, P = 0.312) and 3-year disease-free survival rates (78.8% Compared with 70.1%, P = 0.755), there was no significant difference between the two groups. However, according to intention-to-treat analysis, the 3-year survival rate of patients in the SLT group was significantly better than that in the PLT group (88.4% vs. 76.2%, P = 0.047). Conclusion SLT does not increase the risk of transplant surgery, nor does it affect the long-term prognosis of patients. In some cases, the first surgical resection of liver transplantation can be used as an effective strategy for the treatment of liver cancer.