72例非结直肠源性肿瘤肝转移的外科治疗和预后因素分析  

Liver resection for noncolorectal liver metastases： an analysis of 72 patients

作　　者：段晓峰[1] 董娜娜[1] 张倜[1] 李强[1] 

机构地区：[1]天津医科大学附属肿瘤医院肝胆科,天津市“肿瘤防治”重点实验室,300060

出　　处：《中华肝胆外科杂志》2012年第5期341-345,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨非结直肠源性肝转移的外科治疗和预后相关因素。方法对72例行手术切除的转移性肝癌患者的临床资料进行回顾性分析。72例患者中，男性32例，女性40例；年龄35～78岁，中位55岁。原发肿瘤位于乳腺16例，肺脏14例，食管、胃及小肠12例，胆囊和胰腺8例，妇科肿瘤8例，恶性黑色素瘤4例，肉瘤4例，泌尿系肿瘤2例，其他4例。单发病灶59例，多发病灶13例；肿瘤直径1．5～11cm不等，平均4．8cm。异时性肝转移66例，同时性肝转移6例。结果72例患者中，根治性切除68例（94．4％），镜下切缘阳性4例（5．6％）。本组患者无围手术期死亡。住院天数6～67d，平均14．4d。中位生存时间31（6～127）个月；1年、3年及5年生存率分别为81．9％、37．5％及23．6％。单因素分析显示，原发肿瘤部位（乳腺和非乳腺）、肝转移灶组织学类型（腺癌和非腺癌）、术后是否应用化疗、转移灶个数（单发和多发）以及确诊原发灶与发现肝转移的间隔时间（≤12个月和〉12个月）与患者预后相关（P〈o．05）。多因素分析显示非乳腺来源（P-0．012）、多发肝转移（P-0．008）、确诊原发灶与发现肝转移的间隔时间≤12个月（P-0．027）是影响肝转移癌患者预后的独立危险因素。结论肝切除对于非结直肠源性肝转移癌是安全、有效的治疗方法。确诊原发灶与发现肝转移的时间间隔是影响患者预后的独立因素。对于单发病灶或来源于乳腺的肝转移癌应积极手术治疗。Objective To evaluate the surgical outcomes and prognosis of patients after liver re-section for noncolorectal liver metastases. Methods 72 patients with liver metastases who underwent liver resection at Tianjin Medical University Cancer Hospital were retrospectively studied. There were 32 males and 42 females, aged between 35～78 years. After liver resection, 68 patients had a R0 re-section （negative histological margin）, and 4： patients had a R1 resection （positive histological mar-gin）. The primary tumours were breast, （n = 16, 22.2 %）, lung （n = 14, 19.4 %）, gastrointestinal （n： 12, 16.7%）, gynecological （n = 8, 11.1%）, pancreatobiliary （n ： 8, 11.1%）, melanoma （n=4, 5.6%）, sarcoma （n=4, 5.6%）, and genitourinary （n：2, 2.8%）. The mean diameter of the main tumour was 4.8 cm （range, 1.5-11.0 cm）. The mean number of liver metastases was 1.2 （range, 1-5）. Liver metastases were synchronous in 6 patients （8.3%） and metachronous in the re-maining 66 patients （91.7%）. Results The operative mortality was 0%. The mean hospital stay was 14.4 days （range 6-67 days）. The median overall survival was 31 months （range, 6-127 months）. The 1-, 3- and 5-year survival rates were 81.9%, 37.5% and 23.6%, respectively. Univariate analy-sis revealed primary turnout sites （breast vs. others）, histological type （adenoearcinoma vs. others）, postoperative chemotherapy, number of liver metastases （solitary vs. multiple） and time to liver me-tastases from diagnosis of primary tiamours （412 months vs. ≤12 months） were associated with overall survival （all, P〈0.05）. In multivariate analysis, factors independently associated with poor survival were nonbreast origin （P=0. 012）, time to liver metastases from diagnosis of primary tumours 〈12 months （P=0. 027） and multiple liver metastases （P=0. 008）. Conclusions In select-ed patients, liver resection is an effective and safe treatment for noncolorectal liver metastases. The time to live

关 键 词：肝转移癌 肝切除 预后 

分 类 号：R735.7[医药卫生—肿瘤]