保留肝实质的治疗方式在结直肠癌肝转移手术切除中的应用分析  

Analysis of parenchymal-sparing hepatectomy in surgical treatment of colorectal liver metastases

作　　者：刘铭[1] 王崑[1] 包全[1] 王宏伟[1] 金克敏 闫晓峦 邢宝才[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所肝胆胰外一科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京市100142

出　　处：《中国肿瘤临床》2017年第23期1179-1183,共5页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:81371868)资助~~

摘　　要：目的:探讨保留肝实质的治疗方式在结直肠癌肝转移(colorectal liver metastases,CRLM)手术切除中的意义。方法:回顾性分析北京大学肿瘤医院2000年1月至2016年5月手术切除的CRLM患者377例,根据手术方式分为保留肝实质(parenchymalsparing hepatectomy,PSH)组305例和大范围肝切除(major hepatectomy,MH)组72例。比较两组患者的临床特征、手术情况、术后并发症及预后。结果:PSH组肝转移灶个数少于MH组,差异比较具有统计学意义(P=0.000)。全组采用PSH治疗的患者占80.9%,且随时间增长逐渐增多。PSH组手术时间比MH组短(177.5 min vs.220 min,P=0.000),手术出血比MH组少(150 m L vs.300 m L,P=0.000),术后并发症发生率比MH组低(47.4%vs.64.8%,P=0.008)。PSH组与MH组患者的总生存(overall survival,OS)时间、肝内无复发生存(hepatic recurrence free survival,HFRS)时间差异无统计学意义。PSH组患者复发后接受局部治疗的比例明显增加(42.8%vs.25.6%,P=0.040),复发患者中接受局部治疗的患者生存期明显延长(58个月vs.24个月,P=0.000)。结论:CRLM患者手术时采用PSH的治疗方式肝内复发率更低,安全性更高,复发后再次接受局部治疗的可能性明显增加,是推荐的治疗模式。Objective：To analyze the role of parenchymal-sparing hepatectomy（PSH） in surgical treatment of colorectal liver metastases（CRLM）.Methods：All CRLM patients registered in our database who underwent liver resection were assigned into two groups：the PSH group and the major hepatectomy（MH） group.Clinical characteristics were retrospectively analyzed.Surgical outcomes,survival time,and recurrence were compared between the two groups.Results：A total of 377 patients were enrolled.Except for tumor numbers,no significant difference was found in patient demographics and tumor characteristics between the 2 groups.The rate of PSH increased over the study period.Short-term surgical outcomes were better in the PSH group than in the MH group.Surgery time was significantly shorter（177.5 min vs.220 min,P=0.000）,blood loss was significantly reduced（150 m L vs.300 m L,P=0.000）,and morbidity was significantly reduced（47.4% vs.64.8%,P=0.008）.No significant difference was found in overall survival（OS） time（43 m vs.41 m,P=0.750） between the 2 groups.Hepatic recurrence-free survival time（21 m vs.13 m,P=0.344） was similar between the 2 groups.However,local treatment was more frequently performed in the PSH group（42.8% vs.25.6%,P=0.040） when disease recurred.The 5-year OS was significantly better in patients undergoing local treatment than in those without undergoing local treatment（58 m vs.24 m,P=0.000）,for hepatic recurrence.Conclusion：PSH did not increase hepatic recurrence but improve salvage ability in case of recurrence with a better short-term surgical outcome.PSH should be the recommended approach at initial hepatectomy.

关 键 词：结直肠癌肝转移 肝切除 保留肝实质 复发 局部治疗 

分 类 号：R735.34[医药卫生—肿瘤]