直肠癌合并肝转移时原发肿瘤的手术选择及其疗效评估

目的:回顾性分析本院收治的直肠癌合并肝转移病例，探讨直肠原发灶手术的不同方式。方法：1991年10月～1999年10月，收治直肠癌伴肝转移病例43例，其中男30例，女13例，年龄33～75岁；原发肿瘤位于直肠上段者9例，中段者14例，下段者20例。依据原发肿瘤部位，采取不同的术式，其中直肠前切除者14例，Miles手术者11例，Hartmann手术者7例，结肠造口者11例。结果：全组死亡31例，中位生存时间：直肠前切除者13.8个月，Miles手术者13.7个月，造瘘术者9.2个月；现尚生存者12例(27.9%)，均达一年以上，有2例存活8年，仍在继续随访中；肿瘤未切除而作造瘘术者均已死亡。结论：直肠癌合并肝转移时，对原发肿瘤的处理应采用积极治疗手段，以期延长生存期、改善生存质量。

Surgical Treatment of Primary Rectal Carcinoma with Liver Metastases.

Objective:　To assess the effects of different procedures in the treatment of the primary lesion of rectal cancer associated with liver metastases. Methods:　Retrospective analysis of cases of rectal can-cer with liver metastases admitted from October 1991 to October 1999. Of these 43 patients, 30 were males, 13 were females, age range 33～75 year. The primary lesion of these patients underwent different surgical procedures, including anterior resection in 14 cases, abdominoperineal resection in 11 cases. Hartmann’s operation in 7 cases, and colostomy in 11 cases. Results:　Thirty-one cases of the series died, during the follow-up study, and the median survival time was 13.8, 13.7 and 9.2 months for those undergoing anterior resection, abdominoperineal resection and colostomy respectively. Of the 12 patients who were alive over one year, 2 survived for 8 years. There were no 1-yr survivors among the patients who underwent colostomy. Conclusions:　Aggressive surgical approach for the primary lesion is recommended in cases of rectal cancer associated with liver metastases in order to gain longer survivals.