始终无法切除的结直肠癌肝转移的原发肿瘤外科治疗  

Palliative excisional surgery for primary colorectal cancer in patients with unresectional live metastases

作　　者：吴钢 蔡端 WU Gang CAI Duan(Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, Chin)

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《上海医药》2017年第19期41-45,共5页Shanghai Medical & Pharmaceutical Journal

摘　　要：20%的结直肠癌(CRC)病人在初诊时即为Ⅳ期疾病,这些病人中75%~90%合并不可切除的肝转移(CRLM)。CRLM是CRC治疗的难点,也是其最主要的死亡原因。对于转化治疗失败,肝转移肿瘤始终无法切除的CRLM病人,原发灶出现出血、梗阻或穿孔等并发症时,应姑息性手术治疗。但是,对于无症状或症状轻微的原发肿瘤,其治疗策略仍然存在争议。传统的治疗理念认为,对选择的始终无法切除的CRLM病人姑息性切除原发性肿瘤,然后进行全身化疗,可以使病人的生存受益,并可避免因并发症而急诊手术的必要性。但是,亦有研究认为随着联合化疗和靶向药物的联合使用,可以很好地控制肠道原发病灶,而无需手术治疗,除非出现与之相关的并发症。目前尚无针对该问题的RCT研究提供Ⅰ级证据支持哪种方法对无症状的、始终无法切除的CRLM带来额外的生存受益。Twenty percent of patients with colorectal cancer have stage IV disease at their diagnosis, in which 75%- 90% have unresectable metastases. CRLM is the difficulty of CRC treatment, and the most important cause for death. For patients with unresectable liver metastases who fail to undergo conversion therapy, primary tumors should be surgically removed when primary complications such as bleeding, obstruction or perforation occur. However, the treatment strategies for asymptomatic or mild primary tumors remain to be controversial. According to the traditional concept of treatment, palliative resection of the primary tumor in selected asymptomatic or minimally symptomatic patients with stage IV colorectal cancer should be performed and then undergo systemic chemotherapy, which is associated with longer survival and can reduce the likelihood of complications from the primary tumor and avoid the need for emergency procedures. Some studies reported that the combination chemotherapy and targeted drug could control the primary tumor without palliative surgery, unless there were complications associated with primary tumor. There is no grade I evidence available for the RCT study on this subject, which supports an additional survival benefit for asymptomatic CRLM primary tumors that are always unresectable.

关 键 词：结直肠癌肝转移 姑息性 外科 化疗 

分 类 号：R735.3[医药卫生—肿瘤] R730.56[医药卫生—临床医学]