摘要目的 探讨肝移植治疗肝内胆管癌的临床价值.方法 回顾性分析2007年1月至2013年9月接受肝脏切除术或肝移植术的68例肝内胆管癌患者资料,在肝内胆管癌外科治疗中,以肝切除手术为参照,进行生存分析和预后危险因素分析,明确肝移植治疗肝内胆管癌的临床价值.结果 有55例患者接受肝脏切除术,13例患者接受肝移植术.肝移植组受者1年和3年存活率均明显高于肝脏切除组患者(76.9％与52.7％,61.5％与27.3％,P＜0.05);肝移植组受者1年和3年无复发存活率也明显高于肝脏切除组患者(69.2％与41.8％,61.5％与20.0％,P＜0.05).多因素分析显示,肿瘤大于5 cm为肝内胆管癌的独立危险因素,乙型肝炎病毒感染则为独立保护因素.结论 与肝切除组比较,肝移植组受者预后较好,提示在经过严格筛选且无法手术完整切除的肝内胆管癌患者中,肝移植是可优先考虑的外科治疗方式.

abstractsObjective To investigate the clinical value of liver transplantation for intrahepatic cholangiocarcinoma (ICC).Methods A retrospective analysis was performed on 68 patients with ICC who underwent hepatic resection or liver transplantation between January 2007 and September 2013.In the surgical treatment of ICC,overall survival and prognostic risk factors were analyzed to determine the clinical value of liver transplantation for ICC compared with hepatic resection.Results Of the patients with ICC,55 underwent hepatic resection and 13 were given liver transplantation.The 1 and 3-year survival rate was significantly higher in the liver transplantation group than in the hepatic resection group (76.9％ versus 52.7％,and 61.5％ versus 27.3％,P＜0.05).In addition,liver transplantation resulted in higher tumor recurrence-free survival rate than hepatic resection (69.2％ versus 41.8％,and 61.5％ versus 20.0％,P＜0.05).The multivariate analysis showed that tumor size larger than 5 cm was an independent risk factor and HBV infection was an independent protective factor of ICC.Conclusion The prognosis of patients who underwent liver transplantation was better than hepatic resection,suggesting that liver transplantation is perhaps a prior treatment in strictly selected and unresectable patients with ICC.