结直肠癌肝转移复发再次肝切除术的疗效与预后分析  

Effectiveness and prognosis of repeat liver resection for recurrent liver metastases from colorectal cancer

作　　者：周进学[1] 曹新广[2] 陈小兵[3] 韩风[1] 丁月超[1] 万百顺[1] 

机构地区：[1]河南省肿瘤医院(郑州大学附属肿瘤医院)肝胆外科,河南郑州450008 [2]河南省肿瘤医院(郑州大学附属肿瘤医院)腔镜中心,河南郑州450008 [3]河南省肿瘤医院(郑州大学附属肿瘤医院)内科,河南郑州450008

出　　处：《中国普通外科杂志》2011年第10期1029-1032,共4页China Journal of General Surgery

摘　　要：目的探讨再次肝切除术在结直肠癌肝转移复发治疗中的应用价值。方法回顾性分析43例结直肠癌肝转移复发再次肝切除术和67例结直肠癌肝转移复发内科化疗的临床资料。结果结直肠癌肝转移复发再手术组和化疗组1,3,5年生存率分别为83.7%,51.1%,27.9%和65.7%,20.6%,3.0%(P<0.05或P<0.01)。再次肝切除组无手术死亡病例,并发症发生率为32.6%。单因素分析显示肝脏复发转移灶个数,切缘情况,CEA,肿瘤大小,肿瘤分化程度与预后有关。多因素回归分析结果表明,仅有肝脏复发转移灶个数和肿瘤大小为影响预后的独立因素。结论再次肝切除术对于结直肠癌肝转移复发是安全的治疗方案,肿瘤负荷较小(癌直径<5 cm和转移灶<3个)的患者预后较好;再次手术可以延长结直肠癌肝转移复发患者的生存时间。Objective To determine the value of repeat liver resection for recurrent colorectal liver metastases. Methods The clinical data of 43 patients with recurrent colorectal liver metastases undergoing repeat liver resection and 67 patients with recurrent colorectal liver metastases undergoing systemic chemotherapy were retrospectively analyzed. Results The 1-,3-and 5-year survival rate of the repeat liver resection group was 83.7%,51.1% and 27.9%,respectively,and of the chemotherapy group was 65.7%,20.6% and 3.0%,respectively（P0.05 or P0.01）.In the repeat liver resection group,no operative death occurred and the incidence rate of complications was 32.6%.Univariate analysis suggested that the number of recurrent liver metastasis,condition of the surgical margin,CEA level,tumor size and degree of tumor differentiation were related to the prognosis.Multivariate regression analysis revealed that only the number of recurrent liver metastasis and tumor size were independent risk factors for predicting the prognosis. Conclusions Repeat liver resection is a safe treatment for patients with recurrent colorectal liver metastases,and is especially suitable for those with a low hepatic tumor load（tumor size less than 5 cm and metastases number fewer than 3）.Repeat hepatectomy can prolong the survival of selected patients with recurrent colorectal liver metastases.

关 键 词：结直肠肿瘤 肿瘤转移 肝肿瘤 继发性 再次肝切除术 预后 

分 类 号：R735.3[医药卫生—肿瘤]