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目的探讨符合Milan标准的原发性肝癌切除术后复发行肝移植治疗的可行性及意义。方法收集2000年1月至2008年10月肝癌肝部分切除术后复发小肝癌肝移植(salvage liver transplan-tation,SLT)13例,初次小肝癌(d≤5cm)行肝移植(primary liver transplantation,PLT)32例的资料进行回顾性比较分析。结果 SLT组手术难度、手术时间、术中失血量、住院时间及住院费用均超过PLT组,但围手术期两组并发症发生率无明显差异。术后随访(26±2.6)个月,SLT组和PLT组分别有4例(30.8%)和10例(31.3%)死亡。SLT组6个月、1年、2年生存率分别为84.6%(11/13)、76.9%(10/13)、69.2%(9/13),PLT组分别为93.8%(30/32)、87.5%(28/32)、68.8%(22/32)。结论首次部分肝切除对以后的肝移植手术无明显影响,小肝癌患者行肝部分切除术及补救性肝移植术均为较好的治疗方法。
Objective To investigate the feasibility and significance of the treatment of recurrent liver transplantation after resection of primary liver cancer in line with Milan standard. Methods Thirteen patients with recurrent small hepatocellular carcinoma (SLT) after partial hepatectomy from January 2000 to October 2008 were enrolled in this study. Primary hepatic transplantation (primary hepatic transplantation, PLT) 32 cases were retrospectively analyzed. Results The operation difficulty, operation time, intraoperative blood loss, hospitalization time and hospitalization cost of SLT group were all higher than that of PLT group. However, there was no significant difference in perioperative complications between the two groups. During follow-up (26 ± 2.6) months, 4 (30.8%) and 10 (31.3%) patients died in the SLT and PLT groups, respectively. The 6-month, 1-year and 2-year survival rates of SLT group were 84.6% (11/13), 76.9% (10/13) and 69.2% (9/13), respectively, and those in PLT group were 93.8% (30/32) , 87.5% (28/32), 68.8% (22/32). Conclusions The first partial hepatectomy has no significant effect on the subsequent liver transplantation. Small partial hepatectomy and salvage of liver transplantation in patients with small hepatocellular carcinoma are better methods of treatment.