摘要
目的评价手术治疗结直肠癌肝转移的疗效。方法分析复旦大学附属中山医院2000年1月1日至2005年12月31日收治的470例结直肠癌肝转移患者的资料,评价手术治疗对其生存的影响。结果 196例同时性肝转移患者中手术30例(15.3%),274例异时性肝转移患者中手术103例(37.6%)。同时性肝转移组手术死亡率(3.3%)高于异时性肝转移组(1.9%)(P<0.05)。以2006年6月31日为随访终点,随访率100%,手术患者中同时性肝转移组1、3、5年生存率和中位生存时间与异时性肝转移组相似(P>0.05),但术后复发率较高(36.7%比20.4%,P=0.030)。49例具有手术指征而未手术的患者其1、3、5年生存率明显低于手术患者(P=0.003)。同时性肝转移组中22例Ⅰ期手术切除原发灶和肝转移灶和8例Ⅱ期手术患者的1、2、3年生存率和中位生存时间相似(P>0.05)。生存因素风险分析发现手术切缘达1 cm(P=0.036)和复发后再次手术(P=0.041)是生存的保护性因素,而术后复发(P=0.023)是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施,可以明显改善患者的术后生存。
Objectives To evaluate therapeutic effects of hepatic resection in liver metastasis of colorectal cancer （LMCC）. Methods The clinical data of 133 cases of LMCC received hepatic resection from January 1, 2000 to December 31, 2005 in Zhongshan Hospital were analyzed retrospectively. The relationship between hepatic resection and survival rate was also concerned. Results One hundred and thirty-three cases received curative hepatic resection in all 470 LMCC cases, of which 30 cases from synchronous liver metastasis （SLM） group （ totaled 196 cases） and 103 cases from metachronons liver metastasis （MLM） group（totaled 274 cases）. Mortality rate during operation was 3. 3% in SLM and 1.9% in MLM （P〈0.05）. All patients were followed-up till June 31, 2006, the 1,3,5 year survival rates and median survival time of SLM were similar to those of MLM, but its recurrence rate was higher（36. 7% vs 20. 4% ,P=0. 030）. The 1,3,5 year survival rate in the 49 patients who were operable but received nonoperation treatment were significantly lower than those in operated patients （P = 0. 003）. In 30 SLM cases, 22 received Ⅰ stage resection of their primary and liver metastasis tumor and 8 received liver metastasis resection after the primary surgery （ Ⅱ stage operation）, 1,2, 3 year survival and the median survival time were similar in, the two groups. With COX multivariate analysis, incision margin ≥ 1 cm （ P = 0. 036） and reoperation after＇recurrence （ P =0. 041 ） were protective survival factors, and post-operation recurrence （ P = 0. 023） was survival risk factor. Conclusions Curative hepatic resection is the first choice of therapy in liver metastasis of colorectal cancer and it can improve survival.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第7期452-454,共3页
Chinese Journal of Surgery
关键词
结肠直肠肿瘤
肿瘤转移
外科手术
生存率
Colorectal neoplasms
Tumor metastasis
Surgical procedures, operative
Survival rate
