胃癌伴肝转移的外科治疗

报道经手术及病理证实的胃癌伴肝转移患者３６例，其中行原发病灶切除３１例，单纯胃网膜右动脉注药化疗５例。前３１例在行原发病灶切除的同时对其肝转移灶根据其不同情况而采用转移灶切除、转移灶无水酒精注射、肝固有动脉注药并结扎等处理，其疗效满意。因此，作者认为胃癌即使发生了肝转移也不要轻易放弃手术，在尽可能根治性切除原发病灶的同时处理肝转移灶，再配合其它综合治疗措施，同能起到缓解症状、提高患者生活质量和延长     

外科治疗胃癌肝转移疗效分析

目的探讨外科治疗胃癌肝转移的方法与疗效。方法1996年1月至2003年12月间行外科治疗的胃癌肝转移患者25例，17例为同时性肝转移，8例为术后发现的异时性肝转移。其中单转移灶15例，多转移灶10例。行不规则肝切除16例，左外叶切除4例，左叶切除3例，右叶切除2例，术后行肝动脉灌注化疗9例，肝动脉化疗栓塞16例。结果1例同时性肝切除患者术后死于肺部感染、成人呼吸窘迫综合征，余24例均获随访，中位时间25(7—60)个月。胃癌肝转移灶切除后1、3年生存率为68．5％和29．8％，原发癌浸润表浅、淋巴结转移少、单转移灶、异时性转移及转移灶有包膜是影响生存率的有利因素。结论同时及异时性胃癌肝转移可经外科手术切除肝转移灶，但应注意手术指征的把握。     

胃癌肝转移手术切除与肝动脉门静脉双插管化疗47例体会

中晚期胃癌常常并发肝脏广泛转移,失去根治性手术机会。我院１９９２～１９９７年对４７例胃癌合并肝转移患者采用手术局部切除转移癌结节,结合肝动脉、门静脉双插管注药化疗,取得了较好的疗效。现报告如下。一、临床资料和方法１．一般资料：本组中晚期胃癌伴肝转移４...     

胃癌肝转移的手术治疗

目的 探讨胃癌肝转移行肝切除术的适应证及疗效。方法 对1990年1月至1999年11月间施行肝切除的24例胃癌肝转移患的临床资料进行回顾性分析。结果 本组同时性肝转移19例，异时性转移5例。共施行肝段叶切除8例，肝部分切除16例；19例同时性肝转移患均在肝切除的同时加行根治性胃切除术。术后并发肝昏迷死亡l例。手术死亡率为4．2％。全组22例获得随访。术后1年、3年和5年生存率分别为45．5％、18．2％和9．1％。生存分析显示，肝切除术后的生存率不仅与胃癌原发灶的分化程度、有无浆膜面浸润和淋巴结转移有关，而且与肝转移灶的数目及其在肝脏内的分布范围有关。结论对于胃癌孤立性肝转移患，其原发病灶可根治切除的应积极采用手术治疗，部分患可获长期生存。     

Ⅳ期直肠癌的外科治疗及预后分析

目的 探讨Ⅳ期直肠癌患者原发病灶切除的价值和适应证.方法 回顾性分析1988年1月至2005年12月在外科治疗的118例Ⅳ期直肠癌患者的临床资料,将118例分为二组,手术切除原发病灶组(105例)和仅行造瘘术组(13例).采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较,应用Cox比例风险模型进行多因素分析. 结果 118例中105例行直肠原发病灶切除,同期行转移瘤切除16例;13例行造瘘术.手术切除原发病灶组总的5年生存率为8.5%.其中同期行转移瘤切除者5年生存率31.2%,行辅助化疗者5年生存率20%.手术切除原发病灶组与造瘘组中位生存期分别为15个月、13个月(X2=0.736,P=0.778).手术切除原发病灶组中转移灶切除和转移灶未切除中位生存期分别为20个月、14个月(X2=5.382,P:0.020).手术切除原发病灶加术后全身化疗为主者中位生存期为21个月.多因素分析显示原发肿瘤分化程度、肝转移瘤最大径和全身化疗是影响直肠原发肿瘤切除预后的最主要因素. 结论 对于Ⅳ期直肠癌能同时切除原发及转移病灶的患者,外科手术治疗可延长生存时间.     

Ⅲ期骨肉瘤的治疗

目的探讨Ⅲ期骨肉瘤的诊断、治疗和预后。方法分析1989年12月至2003年12月收治的23例Ⅲ期肢体骨肉瘤患者,男14例,女9例;年龄16～31岁,平均22.4岁。肺转移15例,骨转移7例(跳跃转移5例,骨肉瘤病2例),同时存在肺和骨转移1例。经术前化疗,并行原发肿瘤和转移病灶的切除手术。结果经术前化疗,1例就诊时肺部有1个结节的患者转移瘤消失,1例同时存在肺和骨转移者,切除原发病灶后,出现多处转移,不能行转移灶切除手术;2例骨肉瘤病者仅切除原发病灶;5例跳跃转移者中的2例,切除原发和跳跃转移病灶后,各出现1个肺转移灶。16例行开胸术,其中6例再次出现肺转移灶而行二次开胸术,3例患者二次开胸术后出现肺外转移而放弃治疗。原发病灶与转移病灶的肿瘤坏死率差异无统计学意义。随访5～168个月(平均74.6个月),无瘤生存9例,带瘤生存4例,死亡10例。Cox模型分析提示转移病灶的数目与预后相关(P<0.05)。肺转移与跳跃转移病灶的Kaplan-Meier生存曲线经log-rank检验,差异无统计学意义。结论新辅助化疗及原发病灶和转移灶的手术切除是Ⅲ期骨肉瘤治疗的有效方法,首次肺转移灶切除采用胸骨正中切口,转移瘤的数目与预后相关。     

手术切除胃癌的肝转移灶：22例的17年分析

在胃癌伴肝转移时。手术切除原发和转移灶是惟一的治愈方法。有报道其5年生存率可达0％～1％，而结肠直肠癌肝转移的治愈性切除后5年生存率可达30％～51％。日本东京癌肿研究所医院外科等单位于1985～2001年曾行胃癌切除术4730例。其中106例同时有肝转移(2％)，122例有异时肝转移(3％)。     

胃癌肝转移外科治疗的临床分析

目的 评价胃癌肝转移的外科治疗效果及病理因素对其预后的影响。方法 本组834例胃癌患者中共有91例诊断为肝转移，其中79例为同时性肝转移，12例术后发现异时转移，共21例行胃癌肝转移灶切除术。结果 胃癌肝转移灶切除后1年、3年生存率分别为69％、30％。单转移灶及异时性转移是其有利的预后因素。13例肝转移灶有假包膜形成。结论 单转移灶及异时转移、肿瘤假包膜形成预示胃癌肝转移切除患者有较好的预后。     

结直肠癌肝转移的外科治疗

目的探讨结直肠癌肝转移的手术疗效。方法1996年8月～2000年8月手术治疗结直肠癌肝转移患者31例,行原发癌与转移癌同时切除者9例,结直肠癌根治术后6月再切除肝转移灶者18例;切除肝转移灶后2月再切除原发病灶者4例。原发灶行右半结肠切除5例,横结肠切除4例,左半结肠切除7例,Dixon术12例,Miles术3例。肝转移灶行左外叶切除5例,左半肝切除2例,右后叶切除4例,右前叶切除2例,左或右肝不规则切除18例。结果全组无手术死亡。术后粘连性肠梗阻1例,切口感染3例,经对症治疗后均痊愈出院。平均随访6.4(0.5～8)年,1、2、5年生存率分别为100%、80.6%、29.0%。同期手术者与分期手术者5年生存率分别为33.3%和27.3%,无统计学差异(P>0.05)。结论对结直肠癌肝转移患者应积极争取手术切除,术后可配合其他综合治疗;对原发灶早期诊断、早期手术治疗及辅助化疗有利于防止结直肠癌肝转移。     

大肠癌肝脏转移患者同期外科治疗的远期生存状况分析

目的通过比较同期外科切除的大肠癌肝脏转移患者的临床资料,研究影响其远期生存状况的相关因素。方法回顾性分析2009年1月至2010年12月于我院行同期手术切除的70例大肠癌肝脏转移患者的完整临床资料,观察患者术后的短期及长期疗效,采用单因素与多因素回归分析,研究70例结直肠癌肝转移患者的5年生存情况及影响其远期生存的相关因素。结果本组患者术后30 d无死亡,其中位生存时间为46个月,1年生存率为78.57%,2年生存率为55.71%,3年生存率为48.57%,5年生存率为42.86%;全部70例患者有66例的肝转移灶获得R0切除,包括52例楔形切除、13例半肝切除以及1例扩大切除;另4例为R1切除。并发症共发生9例,占12.86%。单因素分析显示淋巴结转移、术前化疗、肝转移病灶数、肝转移最大直径、癌胚抗原水平以及糖链抗原199对患者的生存率有影响(P0.05),而年龄、性别、原发瘤位置、肿瘤类型、病理类型、肝转移灶分布对患者的生存率无影响(P0.05)。多因素分析结果显示,淋巴结转移、术前化疗、肝转移病灶数、转移灶最大直径是影响患者生存率的独立预后因素。结论淋巴结转移、术前化疗、肝转移病灶数、转移灶最大直径是影响患者远期生存的独立预后因素。     

p53, DCC and thymidylate synthase as predictors of survival after resection of hepatic metastases from colorectal cancer

BACKGROUND: Hepatic metastasis from colorectal cancer is a common problem. Hepatic resection offers the only chance of cure. Prognosis of patients following hepatic resection is currently based on clinicopathological factors (of both the primary cancer and the hepatic metastasis), which do not accurately predict the subsequent behaviour of the tumour. The aim of this study was to evaluate three molecular genetic markers - p53, DCC (deleted in colonic cancer) and thymidylate synthase - in both the primary colorectal tumour and the resected hepatic metastases, and to determine their correlation, if any, with survival in patients with resected hepatic metastases from colorectal cancer. METHODS: Sixty-three patients with hepatic metastases and 40 corresponding colorectal primary tumours were studied using immunohistochemical staining for p53, DCC and thymidylate synthase, as well as p53 gene mutations using polymerase chain reaction-single-stranded conformational polymorphism (PCR-SSCP) analysis. The results were correlated with survival. RESULTS: There was no correlation between p53, DCC or thymidylate synthase immunohistochemical staining, or between p53 PCR-SSCP analysis, and survival for either hepatic metastases or the colorectal primary tumour. CONCLUSION: Prediction of prognosis in patients having resection of hepatic metastases from colorectal cancer continues to be problematic. Other genetic markers or combination of markers need to be evaluated.     

同时性结直肠癌肝转移的临床病理特征分析

目的遴选同时性结直肠癌肝转移的危险因素，为预测和早期诊断肝转移提供参考依据。方法收集2003年1月至2006年12月间收治的367例原发性结直肠癌患者的临床病理资料，对患者的年龄、性别、血型、肿瘤家族史、是否合并肝炎肝硬化、有无合并肠梗阻、术前癌胚抗原（CEA）和CA19－9、原发肿瘤部位和大小、分化程度、肿瘤侵及深度、有无淋巴结转移、肿瘤分期等19项因素进行统计分析。结果本组发生同时性结直肠癌肝转移56例．占同期结直肠癌患者的15．3％。在发病年龄、是否有肠梗阻、是否有盆腔转移结节及肿瘤浸润深度方面，肝转移和无肝转移两组患者之间差异有统计学意义（P〈0．05）。右侧结肠癌肝右叶转移瘤者明显多于左叶，而左侧结肠癌转移瘤多分布于全叶。当术前CEA大于22．1μg／L时，患者发生肝转移的可能性增加。结论结直肠癌同时性肝转移与患者年龄、是否存在肠梗阻、盆腔有无转移及CEA水平存在密切关系。     

How are we treating patients with hepatic colorectal metastases in Sydney?

Introduction: Colorectal cancer is common. At presentation 25% of patients have established hepatic metastases and overall at least half will develop hepatic metastases. Many different therapeutic options have been proposed. This study evaluates the current resources available and patterns of care for patients with hepatic colorectal metastases in the Sydney metropolitan area. Methods: Prospective data were collated describing all patients presenting to any one of nine hospitals within the Sydney metropolitan area in a 12‐month period, diagnosed with hepatic metastases. The data included patient demographics and background, treatment of the primary tumour, diagnosis and treatment of the hepatic metastases and histopathology both of the primary and of the hepatic metastases. Results: There were 194 patients in the study. Most when diagnosed with hepatic colorectal metastases were independent, active, retired and usually had existing social supports. The majority had had their primary colorectal cancer resected and were later treated with systemic chemotherapy. Conclusions: This study highlights the need for a comprehensive multicentre, prospective data collection of patients with hepatic metastatic disease. This would clarify the effectiveness or otherwise of the health system caring for such patients and provide additional information for the development and implementation of guidelines.     

Flow cytometric analysis in colorectal cancer with hepatic metastases and its relationship to metastatic characteristics and prognosis

Nuclear DNA ploidy studies were performed by flow cytometry on extracted nuclei from 65 heptic metastases from colorectal cancer. In 25 patients, both primary and metastatic lesions were available for analysis. Primary carcinomas were DNA diploid pattern in 48.1%, DNA aneuploid in 51.9%. Of 31 hepatic metastases, 11 (35.5%) metastases showed a DNA diploid pattern, and 25 (64.5%) showed a DNA aneuploid pattern. Ploidy pattern was constant between primary and metastases in 80% of tumors. No significant relationship between metastatic characteristics and DNA ploidy pattern was found. The DNA aneuploid cancers had a relatively poorer prognosis in patients with unresectable hepatic metastasis. In resected hepatic metastases from colorectal cancer, rate of hepatic recurrence with DNA diploid pattern was lower than that with DNA aneuploid pattern. Survival of patients with DNA diploid metastases (71% alive at 5 years) was significantly better than that of patients with DNA aneuploid metastases (21% alive at 5 years) (p less than 0.05). These results demonstrated that flow cytometric DNA ploidy measurements may have prognostic value for patients with hepatic metastases from colorectal cancer.     

消化道肿瘤肝转移61例超声造影分析

目的用定量的方法探讨消化道肿瘤肝转移的超声造影特点。方法对61例消化道肿瘤肝转移病人进行超声造影检查,并对超声检查过程进行定量分析,同时与原发性肝癌病人的相应参数进行比较。结果4组消化道肿瘤病人共5个定量参数指标差异无统计学意义（P〉0．05）。原发性肝癌组的峰值增强强度高于肝转移组（P〈0.01）,原发性肝癌组的50％清除斜率低于肝转移组（P〈0．01）。结论消化道来源的肝脏转移病灶在超声造影上有相近的表现,可以利用超声造影检查对消化道肿瘤的肝脏转移病灶进行定量诊断,并与原发性肝癌进行鉴别诊断,有一定的临床应用价值。     

Surgical management of patients with primary operable colorectal cancer and synchronous liver metastases

The surgical results were analyzed of 217 patients who had undergone operation for primary colorectal cancer and were found to have synchronous liver metastases. It is recommended that patients with primary operable colorectal cancer who are found to have synchronous liver metastases should at least have an adequate resection of the primary lesion. If the primary lesion is resectable for cure and there are solitary hepatic metastases, then excision of these seems warranted. In most cases this can be accomplished by simple excision or wedge resection, although occasional cases may require lobectomy.     

The time interval between primary colorectal carcinoma resection to occurrence of liver metastases is the most important factor for hepatic resection. Analysis of total course following primary resection of colorectal cancer

The lack of any other effective treatment for colorectal liver metastases makes hepatic resection a primary treatment consideration. Between January 1980 and December 1996, 36 patients with metachronous liver metastases who underwent hepatic resection were reviewed. The age, sex, site of primary lesion, stage, size and number of hepatic metastases, and time interval between primary colorectal carcinoma resection to occurrence of liver metastases (disease-free interval, DFI) were documented. DFI was 569 days on average. Complete removal of primary colorectal cancer and metastatic liver tumour with histologically negative resection margins was accomplished in all cases. The 5 year survival rate following the first operation for primary colorectal cancer was 43.1%. The length of DFI influenced, independently, patients' prognoses based upon not only univariate but also multivariate survival analysis (P<0.01). We conclude that the DFI is the independent prognostic factor for metachronous liver metastases after curative resection of primary tumour.     

Sequence of colorectal and liver resection in patients with surgically-treatable stage IV colorectal cancer

Approximately 25-30% of patients with colorectal cancer develop hepatic metastases. For patients diagnosed with resectable colorectal hepatic metastases, variation exists regarding the timing of resection of the colorectal primary and the hepatic metastases including three approaches: (1) the “classical” colorectal-first staged approach, (2) the “combined” or simultaneous/synchronous approach, and (3) the “reverse” or liver-first staged approach. The purpose of this chapter is to review the current literature regarding the timing of colorectal and hepatic resection in patients with surgically treatable colorectal adenocarcinoma hepatic metastases. There are inadequate data at the current time to provide definitive recommendations as to the optimal timing and sequence of surgery. Our recommendations based on existing data favor delivery of neoadjuvant therapy followed by either: (1) the combined approach for low-risk resections, (2) the liver-first staged strategy for high-risk hepatic resections or mid- to distal rectal tumors that may benefit from total neoadjuvant therapy, or (3) the colorectal-first approach for symptomatic primary colon tumors.     

胃癌肝转移的外科治疗

目的探讨胃癌肝转移外科治疗的远期疗效。方法回顾性分析1993年1月至2001年10月间938例原发性胃癌患者中32例行胃癌肝转移灶切除者的临床资料。结果938例原发性胃癌患者中,异时性肝转移24例(2.6%),行肝转移灶切除14例(58.3%);同时性肝转移90例(9.6%),行肝转移灶切除18例(20.0%)。32例患者病理检查均证实为肝转移腺癌。术后1、3、5年生存率,异时性肝转移患者为73%、37%、25%;同时性肝转移患者为68%、24%、17%;两者差异无统计学意义(P>0.05)。结论孤立的同时及异时性肝转移患者经外科手术切除肝转移灶预后较好。     

Comparative efficacy of antitumor treatment for liver metastases from colorectal cancer

A retrospective study of 37 colorectal cancer patients with synchronous liver metastases was made. Of these patients, 6 who had undergone primary tumor removal were treated with considerable success by hepatic arterial infusion of 5-FU and mitomycin C. Ten patients who underwent primary tumor excision were treate by oral chemotherapy using fluorinated pyrimidines. These patients survived about 23 months. On the other hand, 12 patients after primary tumor removal without cancer chemotherapy survived for about 10 months. Six patients without antitumor treatment for both primary tumor and hepatic metastasis survived about 5.2 months. The overall results of this study suggest that intrahepatic arterial infusion is of practical importance for hepatic metastases from colorectal cancer and that oral chemotherapy is indeed effective for selected patients.