不同收治时期结直肠癌同时性肝转移同期切除术的临床疗效及预后  

Clinical efficacy and prognosis of simultaneous resection of synchronous colorectal liver metastasis in patients admitted in different phases

作　　者：温镕博 周乐其 樊昊 于冠宇 李刚 龚海峰 朱晓明 王颢 楼征 于恩达 王汉涛 刘连杰 高显华 郝立强 孟荣贵 张卫 Wen Rongbo;Zhou Leqi;Fan Hao;Yu Guanyu;Li Gang;Gong Haifeng;Zhu Xiaoming;Wang Hao;Lou Zheng;Yu Enda;Wang Hantao;Liu Lianjie;Gao Xianhua;Hao Liqiang;Meng Ronggui;Zhang Wei(Department of Colorectal Surgery,the First Affiliated Hospital of Naval Medical University(Changhai Hospital of Shanghai),Shanghai 200433,China;Department of Hepatobiliary Surgery,the First Affilia-ted Hospital of Naval Medical University(Changhai Hospital of Shanghai),Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院(上海长海医院)肛肠外科,上海200433 [2]海军军医大学第一附属医院(上海长海医院)肝胆外科,上海200433

出　　处：《中华消化外科杂志》2022年第6期788-795,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82072750);上海市自然科学基金(20ZR1457200)。

摘　　要：目的探讨不同收治时期结直肠癌同时性肝转移同期切除术的临床疗效及预后。方法采用回顾性队列研究方法。收集2000年1月至2021年4月海军军医大学第一附属医院(上海长海医院)收治的346例结直肠癌同时性肝转移行同期切除术患者的临床病理资料;男217例,女129例;年龄为(58±12)岁。患者均行结直肠癌同时性肝转移同期切除术。观察指标:(1)2000—2010年和2011—2021年收治的结直肠癌同时性肝转移患者临床病理特征。(2)2000—2010年和2011—2021年收治的结直肠癌同时性肝转移患者手术及术后情况。(3)2000—2010年和2011—2021年收治的结直肠癌同时性肝转移患者预后分析。采用电话或门诊方式进行随访,术后2年内每3个月常规检查血常规、肝肾功能、癌胚抗原、CA19-9、腹部B超,每6个月进行胸部CT平扫检查、肝脏MRI和(或)CT增强扫描检查、腹部或盆腔MRI和(或)CT增强扫描检查,2年后每6~12个月检查1次上述项目至术后5年。术后每年检查1次电子结肠镜。了解患者术后生存情况。随访时间截至2021年11月12日。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验。等级资料比较采用秩和检验。采用Kaplan-Meier法计算生存率并绘制生存曲线,Log-Rank检验进行生存分析。结果(1)2000—2010年和2011—2021年收治的结直肠癌同时性肝转移患者临床病理特征。346例患者中,2000—2010年行同期切除术59例;2011—2021年行同期切除术287例。2000—2010年收治的患者性别(男、女),基础疾病(无、有),原发灶淋巴结检出数目(<12枚、≥12枚),原发灶最大径,肝转移灶最大径,肝转移灶数目,术前治疗(无、有),术后治疗(无、有),辅助治疗(围手术期治疗、手术、其他)分别为47、12例,36、23例,19、40例,(5.5±2.4)cm,(2.1±0.7)cm,(1.6±0.5)个,59、0Objective To investigate the clinical efficacy and prognosis of simultaneous resection of synchronous colorectal liver metastasis in patients admitted in different phases.Methods The retrospective cohort study was conducted.The clinicopathological data of 346 patients who underwent simultaneous resection of synchronous colorectal liver metastasis in the First Affiliated Hospital of Naval Medical University(Changhai Hospital of Shanghai)from January 2000 to April 2021 were collected.There were 217 males and 129 females,aged(58±12)years.Patients under-went simultaneous resection of synchronous colorectal liver metastasis.Observation indicators:(1)clinicopathological features of patients with synchronous colorectal liver metastasis in 2000-2010 and 2011-2021;(2)surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000-2010 and 2011-2021;(3)analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000-2010 and 2011-2021.Follow-up was conducted using telephone interview or outpatient examination to detect survival of patients.The follow-up was performed once every 3 months,including blood routine test,liver and kidney function test,car-cinoembryonic antigen(CEA)test,CA19-9 test,abdominal B-ultrasound examination,and once every 6 months,including chest computed tomography(CT)plain scan,liver magnetic resonance imaging(MRI)and/or CT enhanced scan,abdominal or pelvic MRI and/or CT enhanced scan,within postoperative 2 year.The follow-up was performed once every 6-12 months within postoperative 2-5 years including above reexaminations.Electronic colonoscopy was performed once a year after operation.The follow-up was up to November 12,2021.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distuibution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.

关 键 词：结直肠肿瘤 肝转移 同期切除 生存 腹腔镜检查 

分 类 号：R735.34[医药卫生—肿瘤]