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目的:探讨补救性肝移植(SLT)在复发性肝癌治疗中的合理适应证及其临床价值。方法:回顾性分析183例施行肝移植原发性肝癌(HCC)患者的临床和随访资料,分为SLT组(19例)和符合米兰标准的Ⅰ期肝移植(PLT)组(42例)。Kaplan-Meier法比较累积生存率、无瘤生存率,并行Log-rank检验。结果:SLT组和PLT组的无肝期、冷缺血时间、术中出血量、输红细胞(RBC)量、输新鲜冷冻血浆(FFP)量、肝移植并发症发生率、再移植率、围手术期死亡率和肝移植术后肿瘤复发率比较,差异均无统计学意义,P>0.05。仅手术时间差异有统计学意义,P<0.05。SLT组和PLT组1、3和5年累积生存率分别为100.0%、84.2%、84.2%和100.0%、82.5%、79.0%,χ2=0.202,P=0.653;1、3和5年无瘤生存率分别为100.0%、88.8%、88.8%和97.3%、97.3%、97.3%,χ2=1.114,P=0.291。经Log-rank检验差异无统计学意义,P>0.05。结论:SLT是目前肝癌治疗过程中的一种有效策略,严格掌握适应证可以取得与PLT相同的疗效。
Objective: To explore the reasonable indications and clinical value of salvage liver transplantation (SLT) in the treatment of recurrent liver cancer. METHODS: The clinical and follow-up data of 183 patients undergoing liver transplantation for primary liver cancer (HCC) were retrospectively analyzed and were divided into SLT group (19 cases) and Milan-standard stage I liver transplantation (PLT) group (42 cases). The Kaplan-Meier method was used to compare the cumulative survival rate and disease-free survival rate with the Log-rank test. RESULTS: Hepatic period, cold ischemia time, intraoperative blood loss, red blood cell (RBC) volume, fresh frozen plasma (FFP) volume, incidence of complications of liver transplantation, retransplantation rate, and circumference of SLT and PLT groups. There was no significant difference in operative mortality rate and tumor recurrence rate after liver transplantation, P>0.05. Only the difference in operation time was statistically significant, P<0.05. The 1-, 3-, and 5-year cumulative survival rates for SLT and PLT groups were 100.0%, 84.2%, 84.2%, and 100.0%, 82.5%, and 79.0%, respectively, and χ2=0.202, P=0.653; 1, 3, and 5 years without tumors. The survival rates were 100.0%, 88.8%, 88.8%, and 97.3%, 97.3%, and 97.3%, respectively, and χ2=1.114, P=0.291. Log-rank test showed no significant difference, P>0.05. Conclusion: SLT is an effective strategy in the current treatment of liver cancer. Strictly grasping the indication can achieve the same efficacy as PLT.