结直肠癌同时性肝转移同期手术切除疗效分析  

Outcome analysis of simultaneous liver resection for synchronous liver metastases from colorectalcancer

作　　者：胡俊杰[1] 周志祥[1] 梁建伟[1] 王征[1] 周海涛[1] 钟宇新[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院腹部外科,100021

出　　处：《中华肿瘤杂志》2013年第1期63-66,共4页Chinese Journal of Oncology

基　　金：国家自然科学基金（30950013）

摘　　要：目的分析结直肠癌同时性肝转移患者行同期手术切除原发灶和肝转移灶的近期及远期效果，探讨同期手术是否存在优势。方法回顾性分析行手术治疗的53例结直肠癌同时性肝转移患者的临床资料，根据肝转移灶切除时间的不同，分为同期手术组（同期组）40例，分期手术组（分期组）13例，评价两组患者的手术效果。结果同期组和分期组患者的手术时间分别为（212．9±72．3）rnin和（326．5±140．2）rain，术中失血量分别为（337．5±298．0）ml和（594．6±430．5）ml，术后住院时间分别为（16．2±8．1）d和（25．8±8．5）d，差异均有统计学意义（均P〈0．05）。同期组和分期组患者手术并发症的发生率分别为25．O％和53．8％（P=0．053）。两组均无手术死亡患者。同期组患者1、3、5年生存率分别为95．0％、57．0％和37．4％，中位生存时间为40．0个月，中位无病生存时间为14．0个月；分期组患者1、3、5年生存率分别为92．3％、58．7％和36．7％，中位生存时间为38．0个月，中位无病生存时间为13．0个月。两组患者生存时间差异无统计学意义（P〉0．05）。结论同期手术是治疗可切除的结直肠癌同时性肝转移患者安全、有效的措施，与分期手术比较，术中出血少，并发症发生率低，术后住院时问短。Objective To analyze the outcomes of simultaneous liver resection for patients who have primary colorectal cancer with synchronous hepatic metastases to see if there is any advantage for doing so. Methods We retrospectively analyzed the medical records （1999-2009） of 53 consecutive patients with synchronously recognized primary colorectal carcinoma and hepatic metastases who underwent simultaneous （40 patients） or two-stage （13 patients） colonic and hepatic resections performed at our hospital. Results There was no thirty-day mortality in both groups. The two groups had significant differences in mean operation duration [ （212.9 ± 72.3）rain vs. （326.5±140.2）rain, P =0. 014], mean blood loss [ （337.5 ±298.0）ml vs. （594.6 ±430.5 ） ml, P = 0. 020], post-operative hospital stay [ （ 16.2 ± 8.1 ） day vs. （ 25.8 ± 8.5 ） day, P = 0. 001 ]. The incidence rates of post-operative complications were 25.0% （ 10/40 ） and 53.8% （7/13） , respectively, in the two groups （P = 0. 053 ）. The 1-, 3-, 5-year survival rates in the simultaneous resection group were 95.0% , 57.0% and 37.4% , respectively, with a median overall survival of 40.0 months and median disease-free survival of 14.0 months. The 1-, 3-, 5-year survival rates in the two-stage resection group were 92.3% , 58.7% and 36.7% , respectively, with a median overall survival of 38.0 months and median disease-free survival of 13.0 months. There were no significant differences between the two groups in respect of their survivals （P 〉 0. 05）. Conclusions Simultaneous eolectomy and hepatectomy are safe and efficient for colorectal cancer patients who have synchronous colorectal liver metastases, with less complications and blood loss, and shorter hospital stay compared with the two-stage resection.

关 键 词：结直肠肿瘤 肿瘤转移 肝切除术 结肠切除术 

分 类 号：R735.3[医药卫生—肿瘤]