63例大肠癌肝转移患者的回顾性临床分析

目的 回顾性分析影响大肠癌肝转移患者预后的因素,并探讨手术切除加化疗、肝动脉栓塞灌注化疗、姑息化疗治疗大肠癌肝转移的疗效.方法 回顾性分析2001年至2007年间63例大肠癌肝转移患者的临床资料,采用多因素分析方法(Cox模型)分析大肠癌肝转移患者的临床特征、治疗方法及与预后的关系,并比较不同治疗方法的疗效.结果 63例大肠癌肝转移患者中位无疾病进展时间为6个月(0～50个月),中位生存期8个月(1～33个月).单因素生存分析显示术后至发生肝转移时间少于24 个月、术前CEA水平>15ng/ml、淋巴转移数、单纯肝动脉栓塞灌注化疗和姑息化疗的患者预后不良,P<0.05;多因素生存分析发现,治疗方法和术前CEA水平是影响预后的危险因素.结论 采用手术切除加化疗治疗大肠癌肝转移患者疗效较好.     

肝转移癌的外科治疗

肝脏转移癌临床多见,在近10年里其治疗取得很大进步,包括局部治疗、化疗、生物治疗和导向治疗,而手术切除肝脏转移癌是惟一可获长期生存、治愈肝转移癌的有效方法,而且围术期并发症率和死亡率明显降低,无病生存期延长.而非手术治疗仅可有限延长病人生存期或无效[1,2].肝脏转移癌以大肠癌肝转移占多数,21%大肠癌患者初诊时已有肝转移,大部分大肠癌患者发生肝转移在原发肿瘤切除后3年之内[3,4],其他部位或病理类型的恶性肿瘤出现肝转移相对较少.本文结合文献复习,分析了我院2000年至2005年恶性肿瘤肝转移手术切除患者36例的临床资料,现报告如下.     

大肠癌术后肝转移的外科治疗

目的: 探讨大肠癌术后肝转移的手术治疗效果. 方法: 对20例大肠癌术后肝转移病人施行手术切除及/或肝动脉/门静脉插管化疗(DDS),结合文献对手术适应证、手术方式以及随访结果进行分析. 结果: 全组无手术死亡.所有患者跟踪随访2年,1年、2年存活率分别为85.0%和45.0%. 结论: 手术切除是治疗大肠癌术后肝转移的最有效治疗方法.     

老年大肠癌同时性肝转移的外科治疗

目的 探讨老年大肠癌同时性肝转移的外科治疗.方法 对86例大肠癌同时性肝转移的老年患者进行回顾性分析.结果 行同期根治性切除者平均生存期34.07个月,姑息性切除平均生存期12.43个月,单纯结肠造口平均生存期5.6个月. 结论术前正确评估可切除性,合理的围手术期处理,老年大肠癌肝转移行根治性手术切除是可行的,也是最好的治疗选择.     

大肠癌伴肝转移时的外科治疗

肝脏是大肠癌最常见的远端侵犯器官.手术是治疗大肠癌伴肝转移的首选方法,甚至可获得根治的机会,其5年生存率可达30％ ～40％.本文就大肠癌肝转移的手术指征、手术时机、手术方式等新理念进行综述,并探讨外科治疗的决策流程,强调以手术治疗为中心的多学科治疗模式,以提高手术后疗效和生存率.     

大肠癌肝转移的外科治疗

目的探讨大肠癌肝转移的手术治疗效果。方法对30例大肠癌肝转移病人施行手术切除,结合文献对手术适应证、手术方式以及随访结果进行分析。结果全组无手术死亡。中位生存期25.6个月,1、3、5年生存率分别为89.3%、41.8%和14.5%。结论早期诊断及手术切除是治疗大肠癌肝转移的有效方法。     

大肠癌肝转移的外科治疗

大肠癌肝转移的手术治疗效果。方法对２４例大肠癌肝转移病人施行手术切除,结合文献对手术适应证,手术方式以及随访结果进行分析,结果全组无手术死亡。１、３、５年生存率分别为９５．８％、５８．３％和１６．７％。结论手术切除是治疗大肠癌肝转移的有效方法。     

大肠癌肝转移的外科治疗进展

大肠癌肝转移的发生率较高,是治疗失败的主要原因之一,据美国的资料,美国每年新发生大肠癌130,000例,死亡59,000例,其中大约有40,000死于肝转移。六十年代Woodington破除了传统的观点,对转移性肝癌采取外科手术治疗,25例平均生存期35.1月,5年生存率20％。七十年代美国Mayo Clinic和Sloan Kettering癌症纪念中心等发现在转移性肝癌的手术治疗中,来源于大肠癌肝转移治疗效果最好,其结果令人鼓舞。八十年代以来此领域研究更为活跃,文献积累大肠癌肝转移手术治疗的病例已超过千     

大肠癌肝转移的特点及外科治疗

大肠癌肝转移的发生率较高是治疗失败的主要原因,控制肝转移是大肠癌治疗中的重要课题。虽然各种恶性肿瘤都可能转移到肝脏,但由于大肠癌发病率及肝转移发生率均高,癌细胞生长相对较缓慢分化较好,其原发肿瘤控制的可能性较其它癌肿为大。近年来突破了传统的观点,对大肠癌肝转移进行手术切除,     

大肠癌肝转移的治疗进展

肝脏是大肠癌最常见的远处转移器官,正确地处理肝转移是提高大肠癌总体疗效的主要措施之一。手术切除为治疗肝转移的首选,随着相关技术的发展、并发症的减少,手术指征逐步放宽,对手术时机掌握的认识也在发生着变化;对肝转移不能切除的病人,术前化疗是使病人获得手术切除机会的重要方法,术后辅助治疗降低了术后复发率和转移率;肿瘤射频消融与手术联合应用,能使初始不可切除的肝转移癌病人获得长期生存机会。因此,积极的多学科综合治疗,能有效延长病人的生存期,改善患者的预后。     

Endoscopic Treatment of Metastasis in the Main Bronchi From Sarcoma: A Report of 2 Cases

Leiomyosarcoma is a cancer that can affect the soft tissues or organs. The standard treatment is complete tumor resection. Prognosis is difficult to predict and distant metastases can occur after a long disease-free period. Lung metastases are common but metastasis to the main bronchi with pulmonary atelectasis is very rare.We describe 2 cases of pulmonary atelectasis and obstructive pneumonitis due to metastasis to the main bronchi from leiomyosarcoma of the uterus in one of the patients and leiomyosarcoma of the thigh in the other. Both patients were treated with endoscopic resection. We discuss the role of endoscopic laser treatment in the palliation of symptoms and as an initial procedure before other cancer treatments are started.     

Selection criteria for simultaneous resection in patients with synchronous liver metastasis

HYPOTHESIS: While simultaneous resection has been shown to be safe and effective in patients with synchronous metastasis, neoadjuvant chemotherapy followed by hepatectomy has gradually gained acceptance for both initially nonresectable metastasis and resectable metastasis. The boundary between these treatments is becoming unclear. We hypothesized that factors associated with colorectal cancer may play an important role in the prognosis of patients with synchronous metastasis and may be useful for identifying patients who can be expected to have adequate results following simultaneous resection. DESIGN: Outcome study. SETTING: Tertiary referral center. PATIENTS: From January 1980 to December 2002, 187 patients underwent curative resection for synchronous liver metastasis from colorectal cancer. One hundred forty-two patients received simultaneous resection, 18 underwent staged resection, and 27 underwent delayed hepatic resection. Twenty-one clinicopathological factors were analyzed, and long-term prognosis was assessed. MAIN OUTCOME MEASURES: Prognostic factors and patient survival. RESULTS: There was no in-hospital death. In a multivariate analysis, the factors that significantly affected the prognosis of synchronous metastasis were 4 or more lymph node metastases around the primary cancer (P<.001) and multiple liver metastases (P = .003). In patients with 3 or fewer lymph node metastases around the primary cancer, the 5-year survival rates of those with 1, 2 to 3, and 4 or more liver metastases were 63%, 33%, and 40%, respectively, but these rates were 15%, 22%, and 0%, respectively, in patients with 4 or more lymph node metastases around the primary cancer. CONCLUSIONS: The results support the application of simultaneous resection in patients with 0 to 3 colorectal lymph node metastases. However, in patients with 4 or more colorectal lymph node metastases, biological selection by neoadjuvant chemotherapy may be more suitable.     

Surgical and radiosurgical management of brain metastases

When should surgery be used? First, when there is a need to establish the diagnosis of metastatic cancer, particularly in patients who have no known primary lesion. Second, as an effective therapy in patients who have a single brain metastasis, symptomatic or recurrent metastases, or when a metastasis threatens hydrocephalus if treated with radiation alone. Surgery is probably more effective in relieving symptoms from metastases than other treatments,although formal proof of this is lacking. Stereotactic radiosurgery can replace resection when the metastases are smaller than 3 cm and symptoms can be controlled with an acceptable steroid dose. Location of larger lesions in the posterior fossa is a relative contraindication to radiosurgery. The best candidates for resection and radiosurgery are those who have good systemic control of the primary disease; older age is a relative contraindication to resection. Aggressive treatment of oligometastatic brain disease probably is underused in current U.S. practice.     

结直肠癌肝转移的治疗分析

目的总结多种方法治疗结直肠癌肝转移的效果. 方法回顾性分析1995年1月至2003年12月收治的120例结直肠癌肝转移患者的治疗及生存情况. 结果 1、3年生存率,手术切除组分别为83.3%和33.3%,经动脉化疗栓塞组分别为50.0%和15.2%,肝动脉插管皮下埋泵术组分别为47.1%和5.9%,冷冻治疗组分别为55.5%和11.1%,综合治疗组分别为86.7%和40.0%. 结论手术是治疗结直肠癌肝转移的最佳方法,以个体化为原则的术后综合治疗可以提高生存率,降低复发率.     

积极开展对胃癌肝转移的多学科团队综合治疗

胃癌肝转移（GCLM）是晚期胃癌患者死亡的主要原因。GCLM以多发性转移居多．且常伴有肝外病变．特别是腹膜转移,其中绝大多数的肝转移灶无法获得根治性切除。目前,治疗GCLM的方法主要包括根治性手术治疗、胃癌姑息性切除、转移灶消融治疗、介入治疗以及全身化疗等。根据GCLM治疗现状以及解放军总医院普通外科的临床实践,对于GCLM患者,应综合分析患者的全身状态、原发胃癌类型及肝转移程度等,以个体化治疗为原则,通过多学科团队合作,开展积极的综合治疗,选择合适的综合治疗方法。     

结直肠癌根治术后单纯性肺转移60例临床病例分析

目的:结直肠癌患者根治术后大约有50%会发生远处转移,最常见的转移部位是肝,其次是肺,本文旨在探讨结直肠癌根治术后肺转移的特点、治疗效果和影响预后的因素.方法:随访1967年至2002年间的结直肠癌根治术后发生单纯性肺转移的60例病例,对其临床资料进行回顾性分析和总结.结果:自原发灶切除术后全组病例中位生存时间 37 个月,其中有15例行转移灶的切除手术,中位生存 51个月;其余 45例行非手术治疗,中位生存34 个月;转移瘤大于3个组生中位生存时间 30月,转移瘤小于等于3个组中位生存时间43个月.患者的总生存率可能和是否手术、转移灶的个数有关,而年龄、性别、原发灶病理类型、分期、转移灶大小对生存率无明显影响.结论:结直肠癌根治术后单纯性肺转移的积极治疗是有效的,手术及转移灶个数可能是影响治疗效果的因素.     

胃癌肝转移的高危因素和预后

胃癌肝转移是胃癌死亡的主要原因之一。胃癌肝转移多因合并其他非治愈性因素包括腹膜转移、淋巴结转移和肝内广泛转移等而致肝切除率低,患者预后不佳。胃癌肝转移的高危因素主要有原发灶的浆膜浸润、淋巴结转移（N3～N4）、分化型癌、髓样型的低分化腺癌和脉管侵袭以及VEGF、P53、c-erbB-2等的过表达等。无论同时性或异时性的胃癌肝转移．肝切除患者的5年生存率为11％-42％。如能选择合适的肝切除适应证,或会改善胃癌肝转移的预后。     

Neoadjuvant treatments in digestive cancer

Neoadjuvant chemotherapy or chemoradiotherapy is an important concept in the treatment of colorectal liver metastasis, gastric cancer, and esophageal or rectal tumors. This treatment strategy improves disease-free survival and sometimes overall survival. It allows surgical resection of lesions that where not resectable at diagnosis. The new standards of neoadjuvant treatments in gastrointestinal oncology are described in this article.     

Mandibular bone metastasis of rectal cancer: Report of a case

A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.     

Early gastric cancer: diagnosis and less invasive treatments.

The prognosis of early gastric cancer (EGC) is excellent worldwide. Incidence of EGC shows considerable geographic variation, and in high prevalence areas where diagnostic skills are adept, EGCs are not frequently overlooked. In these countries, less invasive, function-preserving treatments such as endoscopic mucosal resection and pylorus-preserving gastrectomy have become standard options. The criteria to apply conservative treatments are being expanded along with the technological improvement. Though its natural history is relatively long, EGC could be a fatal disease and should be carefully treated. Lymph node metastasis is the most important prognostic factor that should be considered in treatment selection and follow-up planning of EGC.