直肠癌肝转移的手术治疗  

Surgical Treatment for Liver Metastasis of Rectal Cancer

作　　者：唐卫[1] 左朝晖[1] 谭春祁[1] 莫胜川[1] 江勃年[1] 欧阳永忠[1] 陈菊英[1] 王心见[1] 

机构地区：[1]湖南省肿瘤医院腹部外科,长沙410013

出　　处：《中国现代手术学杂志》2009年第3期177-179,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨直肠癌肝转移的手术治疗效果。方法回顾性分析186例直肠癌肝转移的临床资料，根据治疗方法分为两组：肝切除组（A组）96例，行直肠癌根治术的同时Ⅰ期行肝切除术，83例同时行FOLFOX方案化疗或TPVCE介入治疗；未切肝组（B组）90例，行直肠癌根治性切除术，术后行FOLFOX方案化疗或TPVCE介入治疗58例，联合术中瘤体注射无水酒精20例，联合放疗12例。分析手术效果及术后生存率。结果A组1例死于肝功能衰竭致肝昏迷，1例吻合口漏致腹腔感染死亡，B组1例死于吻合口漏所致感染性休克。患者术后1、3年累积生存率A组分别为79．8％和44．2％，B组分别为55．1％和20．1％，A组中位生存时间为19（5～38）月，B组为14（3—37）月，两组生存率和中位生存时间有显著性差异（P〈0．05）。结论手术切除是直肠癌肝转移最佳的治疗方法，手术及化疗可以提高生存率、降低复发率。Objective To investigate the effect of surgical treatment for liver metastasis from rectal cancer. Methods Clinical data of 186 cases with hepatic metastasis from rectal cancer were analyzed retrospectively with regard to surgical methods and survival rates. There were 96 cases of hepatectomy group received radical resection of rectal carcinoma and hepatectomy simultaneouly,in whom 83 received FOLFOX chemotherapy or TPVCE interventional therapy. There were 90 cases of non-hepatectomy group underwent radical resection of rectal carcinoma only, and 58 cases were treated by FOLFOX chemotherapy or TPVCE interventional therapy, 20 by combined anhydrous alcoho intratumoral injection, and 12 by combined radiotherapy. Results The 1- and 3-year overall survival rate of the hepatectomy group was 79.8% and 44.2% respectively. The 1- and 3-year overall survival rate of the non-hepatectomy group was 55.1% and 20.1% respectively. The mesosurvival time was 19（5 -38） months and 14 （3 -37） months respectively in the hepateetomy group and the non-hepatectomy group. The survival rates and the meso-survival time between the two groups had significant differences （ P 〈 0.05 ）. Conclusion Hepatectomy can achieve best therapeutic effect for hepatic metastasis from rectal cancer. The surgical treatment combined with the chemotherapy can improve the survival rate and prevent the tumor reeurrence.

关 键 词：直肠肿瘤 肿瘤转移 肝 肝切除术 

分 类 号：R735.37[医药卫生—肿瘤]