大肠癌同时性肝转移外科治疗的预后因素分析  

Prognosis of colorectal cancer with synchronous liver metastasis

作　　者：李玉明[1] 詹文华[1] 韩方海[1] 何裕隆[1] 彭俊生[1] 董文广[1] 汪建平[1] 蔡世荣[1] 马晋平[1] 赵刚[1] 

机构地区：[1]中山大学附属第一医院胃肠胰外科,广州510080

出　　处：《中华普通外科杂志》2005年第10期625-628,共4页Chinese Journal of General Surgery

基　　金：中山大学"211工程"重点学科建设基金资助项目(98097)

摘　　要：目的探讨大肠癌同时性肝转移及其与预后有关的危险因素,提高大肠癌肝转移的诊治水平。方法回顾性分析1994年8月至2004年2月间收治的大肠癌同时性肝转移106例的临床资料,对15项临床病理指标进行统计分析,并用单因素分析和Logistic回归分析与同期收治的无复发性肝转移的大肠癌1052例进行比较。同时对大肠癌肝转移行根治性切除、姑息性切除和探查性手术的生存状况用KaplanMeier法和COX回归方法进行分析比较。结果单因素分析显示,肠梗阻、腹水、盆腔结节、腹膜侵犯、浆膜浸润、周围脏器受累以及肿瘤长径、浸润肠壁的周径、浸润深度都与大肠癌同时性肝转移显著相关;Logistic回归分析发现,浸润深度、浆膜浸润、盆腔转移结节和腹水是影响大肠癌同时性肝转移最重要的因素。根治性切除57例(53.8%),姑息性切除39例(36.8%)和探查性手术后10例(9.4%)平均生存期和中位生存期分别为41.0和34.0个月、23.6和18.0个月以及16.5和12.0个月,三组差异有统计学意义(P=0.0095)。手术方式、肿瘤部位和盆腔结节是影响大肠癌同时性肝转移预后的主要因素。结论大肠癌浸润达浆膜、有盆腔转移结节和腹水者可能合并肝转移,根治性切除可以明显提高大肠癌同时性肝转移的生存率。Objective To explore risk factors of colorectal cancer with synchronous liver metastases and its prognosis. Methods From Aug 1994 to Feb 2004, 106 colorectal cancer patients with synchronous hepatic metastases were enrolled. Fifteen clinicopathological parameters were collected for mono-variable and multi-variable analysis. Treatment result was analyzed by Kaplan-Meier method and COX regression. Results Bowel obstruction, ascites, pelvic nodules, peritoneal invasion, serosal infiltration, organs involvement, tumor size, circumference of bowel invasion, depth of invasion were all individually relevant with synchronous hepatic metastasis. Logistic regression demonstrates depth of invasion, serosal infiltration, pelvic nodules and ascites were most important factors resulting in synchronous hepatic metastases. Radical resection（ 57 cases） , palliative resection （ 39 cases ） and laparotomy only （ 10 cases ） resulted respectively in mean survival time and median survival time of 41, 0 and 34. 0 months, 23.6 and 18, 0 months, 16. 5 and 12. 0 months, respectively （ all P = 0. 0095 ）. Surgery, location of tumor and pelvic nodules were independent prognostic factors. Conclusions Synchronous liver metastasis may present when primary tumor infiltrates serosa, or pelvic nodules and ascites are present. Radical excision significantly improves survival rate.

关 键 词：结肠直肠肿瘤 肿瘤转移 预后 

分 类 号：R735.34[医药卫生—肿瘤] R735.2[医药卫生—临床医学]