结直肠癌切除联合射频消融对同时性结直肠癌肝转移临床指标、安全性及预后的影响

目的 探讨结直肠癌切除联合射频消融治疗同时性结直肠癌肝转移对相关临床指标、患者的安全性及预后生存率的影响,为该疗法在临床的应用提供依据。 方法 回顾性分析2011年1月-2013年12月间绍兴市中心医院收治的同时性结直肠癌肝转移患者48例,根据治疗方法分为观察组和对照组,其中对照组26例接受根治性手术切除结直肠癌变和肝转移部位,观察组22例接受结直肠癌切除联合射频消融。采用t检验比较2组的临床相关指标、并发症发生情况,应用Kaplan-Meier法绘制生存曲线,并采用Log rank检验比较2组患者的预后。 结果 治疗后2组患者的谷丙转氨酶(ALT)和谷草转氨酶(AST)均明显升高,血清白蛋白(ALB)和胆碱酯酶(CHE)均不同程度的降低,而且术后3 d和7 d观察组患者对ALT、AST、ALB和CHE的改善程度均显著大于对照组,以上差异均有统计学意义(P<0.05)。2组的并发症发生率差异无统计学意义(P>0.05)。观察组无进展生存率显著高于对照组,HR=0.420,95%CI:0.131~0.971,P=0.025,而观察组总体生存率与对照组相近,HR=1.623,95%CI:0.748~3.519,P=0.190。 结论 结直肠癌切除和射频消融联合治疗能减少对肝脏功能的损伤,虽然总体生存率与手术切除相比差异无统计学意义,但该疗法为无法进行肝转移灶切除的患者提供了新的治疗方案,具有一定的临床应用价值。 

Effect of resectional therapy combined with radiofrequency ablation on clinical indicators,safety and prognosis of patients with colorectal liver metastasis

Objective To investigate the effect of resectional therapy combined with radiofrequency ablation on clinical indicators, safety and prognosis of patients with colorectal liver metastasis, and provide evidence for the clinical application of this therapy. Methods A retrospective analysis of 48 cases of colorectal liver metastasis in our hospital from January, 2011 to December, 2013 was performed. All the patients were divided into observation group (22 cases) and control group (26 cases) according to the treatment methods. The control group underwent eradicative resection for colorectal cancer and liver metastases, while the observation group underwent resection combined with radiofrequency ablation. T-test was used to compare the clinical relevant indicators and the incidence of complications; Kaplan Meier progression-free survival curve and overall survival curve were done, and Log rank test was used to compare the prognosis of patients between the two groups. Results The levels of alanine aminotransferase (ALT) and aspertate aminotransferase (AST) after the treatment in both groups increased obviously, but the levels of the serum albumin (ALB) and cholinesterase (CHE) decreased in different degree. Three days and seven days after the operation, ALT, AST, ALB and CHE in the observation group were improved significantly as compared with the control group. All the above differences were statistically significant (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The progression-free survival rate of the observation group was significantly higher than that in the control group (HR=0.420, 95% CI:0.131-0.971, P=0.025), while the overall survival rate of the observation group was similar to that of the control group (HR=1.623, 95% CI:0.748-3.519, P=0.190), and there was no statistical difference (P>0.05). Conclusion The resectional therapy combined with radiofrequency ablation for colorectal liver metastasis can reduce the damage of cancer to the liver function, although the overall survival rate in patients is no significant difference as compared with surgical excision. So the new treatment option is available for patients who cannot undergo resectional therapy, which has a certain clinical value.