腹腔镜结直肠癌根治术并脐静脉置泵化疗预防术后肝转移的临床研究

目的:研究腹腔镜结直肠癌根治术后经脐静脉化疗泵持续灌注5-FU对减少术后肝转移、提高远期疗效的作用.方法:为106例患者行腹腔镜结直肠癌根治术,随机分为脐静脉化疗组(研究组,n =53)和对照组(n=53).研究组术中经脐静脉向门静脉插管,术后即从脐静脉化疗泵持续给予5-FU 1g/d,连续7d.对比分析两组近期并发症...     

结直肠癌切除术后预防性门静脉灌注化疗

结直肠癌根治术后 ,肝脏是最常见的转移部位 ( 4 0 % )。防止结直肠癌术后肝转移对改善结直肠癌患者的预后有十分重要意义。一些研究已表明辅助性全身化疗未能提高患者术后生存率[1] 。经门静脉灌注化疗 (ｉｎｔｒａｐｏｒｔａｌｉｎｆｕｓｉｏｎｃｈｅｍｏｔｈｅｒａｐｙ ,ＩＰＩＣ)预防结直肠癌根治术后肝转移逐渐引起学者的关注。一、ＩＰＩＣ的理论基础1.肝脏转移性肿瘤的血液供应 :由于肝脏存在肝动脉及门静脉两套血管系统 ,因此肝转移性肿瘤的血供较其他器官的转移性肿瘤复杂。Ａｒｃｈｅｒ等[2 ] 的研究表明 ,较大的结直肠癌肝转移灶…     

结直肠癌术后行5-FU/LV和FOLFOX4方案化疗的疗效及安全性

目的 分析Dukes B、C期结直肠癌患者根治性手术后,给予5-氟尿嘧啶(5-FU)持续静脉给药联合中剂量甲酰四氢叶酸(LV,5-FU/LV方案)或奥沙利铂(L-OHP)联合5-FU/LV(FOLFOX4方案)辅助化疗的疗效及安全性.方法 对1999年1月至2003年12月188例Dukes B、C期结直肠癌根治术后患者的临床资料进行回顾性分析,Dukes B期、C期均分为单纯手术组、术后5-FU/LV化疗组和FOLFOX4化疗组.结果 Dukes B期:5年生存率分别为单纯手术组67%,术后5-FU/LV辅助化疗组90%,术后FOLFOX4辅助化疗组73%;Dukes C期:3年生存率分别为单纯手术组50%,术后5-FU/LV辅助化疗组76%,术后FOLFOX4辅助化疗组86%.两种辅助化疗方案主要的毒性反应为食欲不振、恶心呕吐、脱发和局部色素沉着,毒性反应多为1～2级,3级毒性反应的发生率分别为9.9%(5-FU/LV)和13.5%(FOLFOX4),未出现4级反应.结论 Dukes B期结直肠癌根治术后行5-FU/LV辅助化疗方案能够提高患者5年生存率,加用奥沙利铂后并不提高5年生存率.而对于Dukes C期患者,行FOLFOX4辅助化疗3年生存率可能优于5-Fu/LV方案.两种辅助方案3级毒性反应发生率低,安全性好.     

胃、结、直肠癌术中门静脉置管术后化疗预防肝转移

目的研究观察在中、晚期胃癌、结、直肠癌根治术中门静脉置管术后化疗对预防肿瘤肝转移的临床疗效。方法选取1998～2002年可行根治性切除的中、晚期胃癌、结、直肠癌患者96例，其中42例术中经胃网膜右静脉置管进入门静脉，1周后经此管给醛氢叶酸（CF）200mg／m^2，第1天，第14天，顺铂（DDP）50mg／m^2滴注，第1天，5～氟脲嘧啶（5-FU）2500mg／m^2，第1天，第14天，以便携式输液泵持续滴注72h。另外54例仅行根治性切除作为对照。结果两组病人全部随访1～3年，观察组中1例出现肝转移，对照组9例出现肝转移。观察组主要不良反应为肝功能损害、发热及胃肠道反应等，经相应对症处理可缓解。结论术中门静脉置管术后化疗对中、晚期胃肠癌术后肝转移的预防有明显效果。     

结直肠癌肝转移的治疗体会

目的 总结结直肠癌肝转移的治疗经验.方法 回顾性分析156例结直肠癌肝转移患者的临床资料,并比较分析肝转移灶切除和原发肿瘤根治术后予以辅助化疗、射频两种治疗方法 的效果.结果 肝叶切除加肝动脉置管化疗(A组,48例)组患者术后1、3、5年生存率分别为83.3%、45.8%和20.0%:而原发肿瘤根治术后予以辅助化疗、射频等综合治疗(B组,108例)者则分别为45.3%,22.1%和5.4%;两组比较,差异有统计学意义(P＜0.01).结论 对肝转移灶应尽可能手术切除.     

结直肠癌术中门静脉化疗对外周血微转移的影响

目的:探讨结直肠癌切除术术中门静脉化疗对术后外周血微转移的影响.方法:确诊为结直肠癌的患者随机分为术中化疗组(化疗组)和单纯手术组(对照组).化疗组患者在术中接受5-FU(1.0 g)的门静脉灌注化疗.术后第1天采外周静脉血,用RT-PCR方法测定CK20阳性率以评价外周血微转移情况.共入选56例患者,其中化疗组28例(10例结肠癌,18例直肠癌),对照组28例(8例结肠癌,20例直肠癌).结果:术后1d化疗组外周静脉血CK20阳性率为21.4％,对照组为60.7％,两组差异有统计学意义(P＜0.05).结论:结直肠癌切除术中进行门静脉化疗可有效预防术后外周血微转移,外周血CK20的测定是一种评价结直肠癌术后外周血微转移的方法.     

结直肠癌术前经肝动脉联合区域动脉灌注化疗的安全性评价

目的 评价术前肝动脉联合区域动脉灌注化疗预防结直肠癌根治术后肝转移的安全性.方法 2001-2007年收治的Ⅱ期和Ⅲ期结直肠癌患者随机分成术前肝动脉联合区域动脉灌注化疗组(介入组,n=256)和对照组(n=253).对两组围手术期的血常规、肝功能、免疫指标、并发症情况等进行评价.结果 介入组介入术后7天(手术前)Ⅲ级肝功能异常、白细胞减少、贫血和血小板减少发生率分别为3.1%(8/256)、5.5%(14/256)、7.4%(19/256)、6.6%(17/256),无Ⅳ级毒副反应,全组均顺利接受手术.介入组和对照组手术后并发症发生率分别为9.8%(25/256)及8.3%(21/253)(X2=1.86,P＞0.05).截至2007年10月,所有患者均接受了随访,平均随访时间42±14个月.介入组和对照组Ⅲ期患者5年总生存率分别为81.0%:60.4%(X2=5.15,P＜0.05)、5年肝转移率分别为18.9%(28/148):27.3%(41/150)(X2=5.41,P＜0.05),Ⅱ期患者肝功能异常、白细胞减少、贫血和血小板减少和免疫指标、并发症情况等两组无差异.结论 术前肝动脉联合区域动脉灌注化疗对结直肠癌手术影响较小,不增加术后并发症的发生,而且可显著降低Ⅲ期结直肠癌术后肝转移发生率,延长患者生存期.     

术中射频联合门静脉置化疗泵治疗结直肠癌肝转移的临床分析

目的观察术中射频联合门静脉置化疗泵治疗结直肠肝转移的疗效、生存期及安全性。方法治疗组10例患者术中切除结直肠原发肿瘤,并术中行肝转移瘤射频消融术及门静脉置化疗泵化疗,对照组既往20例除姑息切除原发肿瘤,术中未行其它治疗。结果治疗组总有效率明显优于对照组,治疗组有效率70.0%,而对照组有效率10.0%,差异有显著性意义(P<0.05);观察治疗组和对照组的1、3、6、12和18个月生存率,治疗组为100%,100%,80.0%,60.0%和60.0%,对照组为70.0%,50.0%,30.0%,5.0%和0,两组差异有显著性意义(P<0.05)。结论术中射频联合门静脉置化疗泵可有效治疗结直肠癌肝转移。     

腹腔镜辅助下结直肠癌根治术40例

目的总结腹腔镜辅助下结直肠癌根治术的经验. 方法经腹腔镜行结直肠癌根治术40例,Dukes A期21例,B期16例,C期3例.其中盲肠癌2例,升结肠癌4例,乙状结肠癌13例,直肠癌21例. 结果 40例均完成腹腔镜辅助手术,手术时间(110.8±23.5)min,术中出血量(150.4±23.2)ml.术后(12.2±3.8)h离床活动,(39.3±4.2)h肛门排气,随访2～72个月,平均38.5个月,除1例拒绝化疗,1年后肿瘤复发外,其余均未见肿瘤转移、局部复发、trocar处及小切口处肿瘤种植. 结论 Dukes分期A、B、C期的结直肠癌可行腹腔镜下结直肠癌根治术.可以达到恶性肿瘤根治性手术的淋巴结廓清.     

结直肠癌同时性肝转移治疗46例分析

目的:探讨结直肠癌同时性肝转移的有效治疗方法。方法:对1996～2004年收治的46例结直肠癌同时性肝转移的临床资料和随访资料进行回顾性分析。根据治疗方法的不同分为3组:A组21例,为一期切除原发灶和肝转移灶并经肝动脉和门静脉置泵化疗者;B组15例,为单纯原发灶切除并经肝动脉和门静脉置泵化疗者;C组10例,为原发灶和肝转移灶均未能切除而仅行肝动脉和门静脉置泵化疗者。用KaplanMeier法对病人的生存时间作统计分析。结果:A、B、C3组术后中位生存期分别为38、20和13个月;各组之间术后生存时间的比较均有显著统计学差异(P<0.01)。结论:结直肠癌原发灶和肝转移灶一期手术切除并经肝动脉和门静脉置泵化疗的疗效最好;肝转移灶无法切除者能将原发灶切除并经肝动脉和门静脉置泵化疗也可取得较好的疗效;原发灶和肝转移灶未能切除而仅经肝动脉和门静脉置泵化疗的疗效相对较差。对结直肠癌同时性肝转移应采取以手术切除为主的综合措施进行积极治疗。     

Adjuvant regional chemotherapy after hepatic resection for colorectal metastases.

BACKGROUND: This study explored the possibility of achieving a better survival rate and reduced recurrence in the remaining liver in patients with colorectal hepatic metastases undergoing hepatic resection. Adjuvant postoperative regional chemotherapy was administered via the hepatic artery or the portal vein. METHODS: A retrospective study was performed on 174 patients after hepatic resection for colorectal metastases. These comprised 78 patients who had hepatic artery infusion (HAI) chemotherapy (HAI group), 30 who had portal vein infusion (PVI) chemotherapy (PVI group) and 66 who had no regional chemotherapy (resection alone group). The three groups were compared with one another in terms of complications, survival rate and patterns of recurrence. RESULTS: Severe complications did not occur at any point during adjuvant HAI or PVI chemotherapy. The 5-year disease-free survival rate of patients in the HAI, PVI and resection alone groups were 35, 13 and 9 per cent respectively, including six hospital deaths. Patients in the HAI group showed significantly improved recurrence rates in the remaining liver compared with the resection alone group (P = 0.03), and more prolonged disease-free and overall survival than those in the PVI (P = 0.01 and P = 0.02 respectively) and resection alone (P = 0.0001 and P = 0.0006 respectively) groups. CONCLUSION: This study suggests that adjuvant HAI chemotherapy after hepatic resection may have therapeutic potential for improved management of patients with colorectal metastases.     

结直肠癌肝转移综合治疗体会

目的总结分析综合疗法控制结直肠癌肝转移的效果和体会。方法回顾性分析1996．1-2004．12结直肠癌肝转移106例临床资料。结果术前发现肝转移者行同期肝转移灶切除16例，门静脉化疗泵植入5例；术后发现肝转移灶者85例行手术切除、全身化疗、射频消融（PRFA）、无水酒精注射（PEI）、经导管肝动脉化疗栓塞（TACE）等综合治疗。无手术死亡。治疗后CEA转阴29．2％，下降56．9％。随访率92．5％，随访期8个月至5年。缓解率（CR＋PR）为92．9％。病人1，3，5年生存率分别为96．9％、51．8％和23．2％。结论积极手术切除，配合局部消融和全身化疗的综合治疗是控制结直肠癌肝转移的有效方案。     

Liver perfusion chemotherapy for selected patients at a high-risk of liver metastasis after resection of duodenal and ampullary cancers

OBJECTIVE: To evaluate the prognostic benefit of postoperative liver perfusion chemotherapy (LPC) in patients who undergo curative resection of duodenal and ampullary cancers. SUMMARY BACKGROUND DATA: Both nodal involvement and pancreatic invasion are poor prognostic indicators after curative resection of ampullary or duodenal cancers due to high incidences of liver metastasis. Therefore, we have performed postoperative LPC on a number of such "high-risk" patients. METHODS: During the period of 1990 to 2005, 72 consecutive patients successfully underwent curative (R0) resection of duodenal or ampullary carcinomas at our institution, The Osaka Medical Center for Cancer and Cardiovascular Diseases. Of these 72 patients, 38 were found to have positive nodal involvement and/or pancreatic invasion based on an intraoperative inspection, and of these, 28 were deemed to be suitable candidates for intraoperative catheterization: 1 catheter was placed into the gastroduodenal artery; another into the portal vein (group A). Postoperatively, they received an infusion of 5-fluorouracil (5-FU: 125 mg/d) via each of the 2 catheters for a period of 28 continuous days. The remaining 44 patients (group B) did not receive any other adjuvant therapy. The survival rates and patterns of disease failure were compared between these 2 groups and their subgroups. RESULTS: All 72 patients survived the operation, and all 28 patients in group A completed their courses of LPC without showing any significant adverse signs. Postoperative histopathology was later performed to get a more accurate picture regarding the degree of nodal involvement and/or pancreatic invasion: In group A, 21 patients (group A1) proved positive for nodal and/or pancreatic invasion whereas 7 patients (group A2) proved negative; and in group B, 16 patients proved positive (group B1) whereas 28 proved negative (group B2). Although group A displayed higher incidences of nodal involvement and pancreatic invasion, the 5-year survival rates for the 2 groups varied only slightly. The 5-year survival rate was 70% in group A1, 85% in group A2, 35% in group B1, and 92% in group B2, respectively. The difference between B1 and B2 and the difference between A1 and B1 were statistically significant, and these differences were conclusively found to be attributable to the different incidences of liver metastasis. CONCLUSION: Through this research, both nodal involvement and pancreatic invasion were confirmed to be reliable predictors of liver metastasis after curative resection of ampullary and duodenal cancers. Since LPC was proven to be effective in preventing the postoperative development of liver metastasis, it should be more actively performed for patients with a high-risk of liver metastasis.     

门静脉化疗对合并癌栓的原发性肝癌术后复发的预防作用

目的　探讨门静脉导管保留术并根据体外肿瘤药敏试验定期行门静脉化疗对合并门静脉癌栓的原发性肝癌术后复发的预防作用。方法　术前经B型超声或CT证实有门静脉癌栓的原发性肝癌病人 6 2例随机分成对照组 (2 9例 )和治疗组 (33例 )。治疗组在肝癌联同门脉癌栓切除术中常规行门静导管保留术 ,术后根据体外肿瘤药物敏感性试验选用敏感性化疗药物定期行门静脉化疗。对照组在肝癌及门静脉癌栓切除术后未行特殊治疗。结果　对照组与治疗组术后半年、1年复发率分别为 1 4例 (4 8.3% )、2 2例 (75 .9% )和 9例 (2 7.3% )、1 6例 (4 8.5 % ) ;两组术后半年、1年死亡率分别为 1 1例 (37.9% )、1 9例 (6 5 .5 % )与 6例 (1 8.2 % )、1 2例 (36 .4 % )。两组比较均有显著性差异 (P <0 .0 5 )。结论　肝细胞肝癌伴门静脉癌栓行手术切除有较好的疗效。而术后根据药物敏感性试验通过门静脉化疗可明显降低术后复发率 ,延长生存期     

直肠癌根治术后髂内动脉加门静脉置泵化疗预防局部复发和肝转移的研究

目的探讨髂内动脉加门静脉置泵化疗预防直肠癌术后局部复发和肝转移的价值.方法将我院96例直肠癌术前随机分成两组,门静脉加髂内动脉灌注化疗组(治疗组)48例与外周静脉化疗组(对照组)48例,对其疗效进行分析.结果治疗组1、3、5年生存率分别是100%、83%、52%;局部复发率和肝转移率是13%、13%.对照组是88%、68%、32%,26%、28%.两组各项指标分别比较,差异有显著意义(P<0.01).结论置泵灌注化疗在预防直肠癌术后局部复发和肝脏转移的治疗效果优于外周静脉全身化疗.     

The management of solitary colorectal liver metastases

Surgical resection of solitary colorectal liver metastases is associated with long-term survival. Radiofrequency ablation used as the primary treatment option of solitary resectable colorectal liver metastases is associated with an increased risk of local recurrence that generally leads to worse survival compared to resection. In contrast with treatment of other hepatic malignancies, radiofrequency ablation is not equivalent to resection for colorectal liver metastases and should not be used as an alternative but limited to inoperable patients. Although overall survival rate after resection can be up to 71% at 5 years, the majority of patients develop recurrence. Preoperative chemotherapy contributes to decrease the risk of recurrence after resection of colorectal liver metastases. In patients with advanced solitary colorectal liver metastasis initially non suitable for resection, chemotherapy and portal vein embolization contribute to increase the number of surgical candidates whereas radiofrequency is rarely an option.     

术后髂内动脉和肝动脉联合灌注化疗对直肠癌患者盆腔复发和肝转移的预防作用

目的研究直肠癌根治性切除术后预防性髂内动脉和肝动脉联合灌注化疗对盆腔复发和肝转移的抑制作用。方法84例获得根治性切除的直肠癌DukesB、C期患者,术后41例予以预防性经导管双侧髂内动脉和肝动脉联合灌注化疗,同时结合静脉化疗(观察组);另43例单纯静脉化疗(对照组);随访5年内患者盆腔复发和肝转移的发生情况及生存情况,前瞻性对照研究两组患者的疗效。结果观察组5年内肝转移和盆腔复发的发生率为17.1%和9.8%;对照组则为30.2%和18.6%;两组差异有统计学意义(χ2=4.31,P<0.05)。观察组复发病例的平均无瘤生存期26.2个月,明显长于对照组的15.8个月(t=5.05,P<0.01)。观察组患者5年生存率65.9%,明显高于对照组的56.5%(u=8.68,P<0.01)。Cox风险比例模型分析显示,观察组盆腔复发和肝转移的风险较对照组减少20%[危险度0.7959],5年内死亡的风险同比下降20%[危险度0.8034]。结论直肠癌根治术后早期预防性地进行髂内动脉和肝动脉联合灌注化疗可有效降低和抑制盆腔局部复发率和肝转移的发生率,提高5年生存率。