• 復旦大學附屬中山醫(yī)院肝癌研究所(上海 200032);

目的探討挽救性肝移植(SLT)的手術安全性及對患者預后的影響。方法回顧性分析復旦大學附屬中山醫(yī)院肝外科2001年6月至2008年12月期間連續(xù)289例肝癌肝移植(符合UCSF標準)患者的臨床資料，其中242例患者行初始肝移植(PLT),即PLT組，47例患者行SLT，即SLT組，比較2組患者圍手術期及長期生存情況的差異。結果2組患者的平均年齡、性別構成及腫瘤情況差異均無統(tǒng)計學意義(P gt;0.05)。SLT組的手術時間要長于PLT組〔(7.1±1.8) h比(6.4±1.4) h， P=0.004〕，但2組患者的術中出血量〔(2 560.5±2 683.6) ml比(2 042.9±2 006.2) ml， P=0.173〕及術中輸血量〔(13.8±12.9) U比(9.9±12.6) U， P=0.087〕比較差異均無統(tǒng)計學意義。SLT組患者從第1次手術切除至行肝移植的間隔時間為(32.8±32.4)個月。截至2009年12月，2組患者中位隨訪時間為38.7個月，SLT組與PLT組患者的3年生存率(82.3% 比 75.5%， P=0.312)和3年無瘤生存率(78.8%比70.1%， P=0.755)之間比較差異均無統(tǒng)計學意義。但按意向性治療分析，SLT組患者的3年生存率明顯優(yōu)于PLT組(88.4% 比76.2%， P=0.047)。結論SLT并不增加移植手術的風險，也不影響患者的長期預后，對部分病例，先行手術切除再行肝移植可作為肝癌治療的一種有效策略。

引用本文： 王征,樊嘉,周儉,邱雙健,黃曉武,孫健,肖永勝,宋康,沈早卓. 挽救性肝移植治療肝癌切除術后復發(fā)的價值研究. 中國普外基礎與臨床雜志, 2011, 18(4): 362-365. doi: 復制

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1. Zhou J, Fan J, Wu ZQ, et al. Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China [J]. Chin Med J (Engl), 2005, 118(8): 654659.
2. Graziadei IW, Sandmueller H, Waldenberger P, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome [J]. Liver Transpl, 2003, 9(6): 557563.
3. Bolondi L, Piscaglia F, Camaggi V, et al. Review article: liver transplantation for HCC. Treatment options on the waiting list [J]. Aliment Pharmacol Ther, 2003, 17 Suppl 2: 145150.
4. Maddala YK, Stadheim L, Andrews JC, et al. Dropout rates of patients with hepatocellular cancer listed for liver transplantation: outcome with chemoembolization [J]. Liver Transpl, 2004, 10(3): 449455.
5. Pierie JP, Muzikansky A, Tanabe KK, et al. The outcome of surgical resection versus assignment to the liver transplant waiting list for hepatocellular carcinoma [J]. Ann Surg Oncol, 2005, 12(7): 552560.
6. Llovet JM, Fuster J, Bruix J. Intentiontotreat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation [J]. Hepatology, 1999, 30(6): 14341440.
7. 李波, 嚴律南, 袁丁, 等. 肝切除術后復發(fā)性肝癌的肝臟移植 [J]. 中國普外基礎與臨床雜志, 2010, 16(3): 191194.
8. 楊國歡, 樊嘉, 周儉, 等. 肝癌患者肝切除術后再行肝移植與直接行肝移植的療效評估 [J]. 中華普通外科雜志, 2008, 23(7): 484486.
9. BennettGuerrero E, Feierman DE, Barclay GR, et al. Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation [J]. Arch Surg, 2001, 136(10): 11771183.
10. Makuuchi M, Sano K. The surgical approach to HCC: our progress and results in Japan [J]. Liver Transpl, 2004, 10(2 Suppl 1): S46S52.
11. Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? [J]. Ann Surg, 2003, 238(4): 508518.
12. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma [J]. Ann Surg, 2003, 238(6): 885892.
13. Poon RT, Fan ST. Is primary resection and salvage transplantation for hepatocellular carcinoma a reasonable strategy? [J]. Ann Surg, 2004, 240(5): 925928.
14. Del Gaudio M, Ercolani G, Ravaioli M, et al. Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience [J]. Am J Transplant, 2008, 8(6): 11771185.
15. Margarit C, Escartín A, Castells L, et al. Resection for hepatocellular carcinoma is a good option in ChildTurcottePugh class A patients with cirrhosis who are eligible for liver transplantation [J]. Liver Transpl, 2005, 11(10): 12421251.
16. Schwartz M, Dvorchik I, Roayaie S, et al. Liver transplantation for hepatocellular carcinoma: extension of indications based on molecular markers [J]. J Hepatol, 2008, 49(4): 581588.
17. Sala M, Fuster J, Llovet JM, et al; Barcelona Clinic Liver Cancer (BCLC) Group. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation [J]. Liver Transpl, 2004, 10(10): 12941300.
  1. 1. Zhou J, Fan J, Wu ZQ, et al. Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China [J]. Chin Med J (Engl), 2005, 118(8): 654659.
  2. 2. Graziadei IW, Sandmueller H, Waldenberger P, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome [J]. Liver Transpl, 2003, 9(6): 557563.
  3. 3. Bolondi L, Piscaglia F, Camaggi V, et al. Review article: liver transplantation for HCC. Treatment options on the waiting list [J]. Aliment Pharmacol Ther, 2003, 17 Suppl 2: 145150.
  4. 4. Maddala YK, Stadheim L, Andrews JC, et al. Dropout rates of patients with hepatocellular cancer listed for liver transplantation: outcome with chemoembolization [J]. Liver Transpl, 2004, 10(3): 449455.
  5. 5. Pierie JP, Muzikansky A, Tanabe KK, et al. The outcome of surgical resection versus assignment to the liver transplant waiting list for hepatocellular carcinoma [J]. Ann Surg Oncol, 2005, 12(7): 552560.
  6. 6. Llovet JM, Fuster J, Bruix J. Intentiontotreat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation [J]. Hepatology, 1999, 30(6): 14341440.
  7. 7. 李波, 嚴律南, 袁丁, 等. 肝切除術后復發(fā)性肝癌的肝臟移植 [J]. 中國普外基礎與臨床雜志, 2010, 16(3): 191194.
  8. 8. 楊國歡, 樊嘉, 周儉, 等. 肝癌患者肝切除術后再行肝移植與直接行肝移植的療效評估 [J]. 中華普通外科雜志, 2008, 23(7): 484486.
  9. 9. BennettGuerrero E, Feierman DE, Barclay GR, et al. Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation [J]. Arch Surg, 2001, 136(10): 11771183.
  10. 10. Makuuchi M, Sano K. The surgical approach to HCC: our progress and results in Japan [J]. Liver Transpl, 2004, 10(2 Suppl 1): S46S52.
  11. 11. Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? [J]. Ann Surg, 2003, 238(4): 508518.
  12. 12. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma [J]. Ann Surg, 2003, 238(6): 885892.
  13. 13. Poon RT, Fan ST. Is primary resection and salvage transplantation for hepatocellular carcinoma a reasonable strategy? [J]. Ann Surg, 2004, 240(5): 925928.
  14. 14. Del Gaudio M, Ercolani G, Ravaioli M, et al. Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience [J]. Am J Transplant, 2008, 8(6): 11771185.
  15. 15. Margarit C, Escartín A, Castells L, et al. Resection for hepatocellular carcinoma is a good option in ChildTurcottePugh class A patients with cirrhosis who are eligible for liver transplantation [J]. Liver Transpl, 2005, 11(10): 12421251.
  16. 16. Schwartz M, Dvorchik I, Roayaie S, et al. Liver transplantation for hepatocellular carcinoma: extension of indications based on molecular markers [J]. J Hepatol, 2008, 49(4): 581588.
  17. 17. Sala M, Fuster J, Llovet JM, et al; Barcelona Clinic Liver Cancer (BCLC) Group. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation [J]. Liver Transpl, 2004, 10(10): 12941300.