结直肠癌肝转移一期联合手术化疗的临床研究

目的探讨结直肠癌肝转移一期联合手术辅助化疗的有效途径及临床价值.方法回顾性分析一期联合手术切除原发癌及转移癌,经肝动脉门静脉双置泵栓塞灌注化疗,肿瘤局部注射无水酒精及热电疗法综合性治疗结直肠癌肝转移36例的临床资料.结果本组36例结直肠癌患者原发癌均获切除,其中一期切除肝转移癌17例,6例复发,4例再次手术切除.19例不能切除的转移性肝癌,行肝动脉门静脉双置泵栓塞灌注化疗,无水酒精注射和热电疗法.肿瘤直径平均缩小57%,其中4例因肿瘤缩小行二期手术切除.1、2、3年生存率分别为切除组94%,82%,65%;明显高于置泵组的74%,53%,32%(P<0.01).结论结直肠癌肝转移一期联合手术切除加肝动脉门静脉双置泵栓塞灌注化疗,是一种首选而有效的治疗方法.不能切除肝转移癌者,只要切除原发肿瘤,肝动脉门静脉置泵栓塞灌注化疗,可明显延长病人生存期,改善预后.     

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。     

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.     

同期手术治疗胃及结直肠肿瘤伴肝转移28例临床分析

目的探讨胃及结直肠肿瘤合并肝转移患者的手术治疗效果。方法 2008年1月至2012年12月,32例伴肝转移的胃及结直肠肿瘤收治入院。对患者进行手术耐受性、手术切除可能性及手术风险评估。对于有手术指证并愿意接受手术的28例患者行手术治疗。胃肠道肿瘤根治术及肝转移灶切除术15例(其中2例行化疗泵植入术),胃及结直肠肿瘤切除术7例(其中2例行化疗泵植入术),胃空肠吻合术1例,结肠侧侧吻合术4例(其中行化疗泵植入术2例),剖腹探查化疗泵植入术1例。术后化疗6个月,并终身随访。结果无手术死亡,术后3例出现腹腔积液,经置管引流后恢复良好,1例术后一周出现吻合口漏,予灌注冲洗低压持续引流两周后痊愈。术后肺部感染6例经抗感染治疗后痊愈,1例术后出现腹腔感染,经抗炎治疗后痊愈。一年生存率82.1%,两年生存率42.9%,三年生存率25%。结论胃肠道肿瘤合并肝转移并非手术绝对禁忌证,选择合适的患者,采取积极的外科手术治疗,可以获得较好的疗效。     

结直肠癌切除同期射频消融联合化疗治疗肝转移

目的：探讨结直肠癌切除同期射频消融联合化疗治疗肝转移的临床疗效。方法：对39例病人先行原发肿瘤的切除，同期行射频消融联合化疗治疗肝转移，以螺旋CT增强扫描为主结合彩超综合评价治疗效果。结果：39例共82个肝转移病灶，完全坏死率85％。随访时间〉6个月者3l例，生存27例；随访时间〉12个月11例，生存8例。结论：结直肠癌切除同期射频消融联合化疗治疗肝转移的疗效较好，值得临床推广。     

腔镜下微波消融联合术后经脐静脉插管化疗治疗结直肠癌肝转移

目的探讨腹腔镜结直肠癌切除及脐静脉插管同期微波消融联合术后化疗治疗肝转移的临床疗效。方法在腹腔镜下对1I例结直肠癌肝转移行结直肠癌切除及经肝圆韧带脐静脉插管置泵,同期行肝脏转移瘤微波消融治疗,术后辅以经化疗泵介入化疗。比较治疗前后肿瘤直径大小、血供及坏死情况。结果本组治疗前CT检测转移瘤直径为（4．2±2．5）cm,治疗后为（2．5±1．2）cm,转移瘤结节完全坏死8例（72．7％）。随访时间〉6个月者10例,生存10例;随访时间〉12个月者8例,生存6例。结论腹腔镜结直肠癌切除及脐静脉插管同期微波消融联合术后化疗治疗肝转移的疗效好,值得临床推广。     

结直肠癌肝转移的转化治疗

对结直肠癌肝转移来说,手术是惟一的治愈手段。但80%的病人初始是不可切除的,将不可切除肝转移转化为可切除是提高结直肠癌总体存活率的关键。目前常用的转化手段有全身化疗（包括单纯化疗、化疗联合靶向药物等）、肝动脉灌注（HAI）、射频消融（RFA）、联合门静脉结扎或栓塞的分期肝切除、联合肝脏分隔及门静脉结扎的二步肝切除等。了解各种转化治疗的有效率和适应证是选择合适治疗的前提。     

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。     

超选择置泵灌注化疗在大肠癌中的应用

目的　评价术中超选择靶区动脉置泵 ,术后皮下泵内反复区域性灌注化疗药物治疗大肠癌的临床疗效。方法　对我院 2 93例大肠癌患者 ,经术中选择性肿瘤供血动脉内置泵 ,术后泵内灌注化疗药物的疗效进行回顾性分析 ,其中根治性切除 2 14例 ,晚期不能手术切除 79例。结果　根治性切除组 1年、3年、5年生存率分别为 10 0 %、84 .6 %、57.5% ,局部复发率和肝转移率分别为 13.6 %、12 .1% ;不能手术切除组完全缓解 4例 ;部分缓解 6 2例 ;稳定 13例 ,治疗有效率 (PR CR)为 83.5% ,置泵术后 0 .5年、1年、2年生存率分别为 96 %、86 .6 %、4 4.6 %。结论　超选择动脉置泵灌注化疗是治疗大肠癌的有效方法 ,它可以降低局部复发率和肝脏转移率 ,提高患者生存率。     

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...     

结直肠癌辅助门静脉持续灌注化疗与肠腔化疗疗效的对比研究

目的　比较结直肠癌根治术后经门静脉持续灌注 5 FU 7d与术中肠腔一次给药化疗对减少术后肝转移、提高术后远期疗效的作用。方法　行根治性手术的结直肠癌患者 16 2例 ,随机分为门静脉化疗组 (A组 ) 82例和肠腔化疗组 (B组 ) 80例 ,两组的年龄、性别、肿瘤部位、肿瘤大小、Dukes′分期等差异均无显著意义 (P >0 0 5 )。A组术中经大网膜静脉向门静脉插管 ,导管远端引出腹壁固定 ,术后即从门静脉导管持续给予 5 FU 1g/d ,连续 7d ,B组术中用肠腔化疗加一次性经大网膜静脉注射 5 FU。用SPSS8 0分析比较两组的近期并发症及远期疗效。结果　A组术后并发症较多 ,但平均住院时间及生存曲线等指标两组差异无显著意义 (P >0 0 5 )。全组 5年生存率 76 7% (A组74 3% ,B组 79 2 % )。用Gehan法检验两组生存曲线 ,其差异也无显著意义。全组肝转移率为19 8%。多因素分析显示 ,影响本组预后的因素为Dukes′分期 (P <0 0 5 )。结论　结直肠癌根治术后经门静脉持续灌注 5 FU 7d的辅助化疗方法与肠腔化疗对预防肝转移、提高生存率有一定的作用 ,二者疗效相当 ,但后者更简便     

埋植式药泵在肝癌治疗中的应用

目的　探讨对不能切除的肝癌患者术中应用埋植式药泵治疗的临床意义。方法　对2 8例肝癌患者 ,术中作肝动脉和门静脉插管并皮下埋植药泵 ,术中、术后经药泵进行肝脏局部灌注化疗取得了较好的疗效。结果　本组治疗后有效率为 6 4.2 % ,其中生存时间小于 6个月 15例 ,6～12个月 10例 ,12个月以上 3例其中 1例存活 2 2个月以上。结论　肝动脉局部灌注化疗对不能手术切除的晚期肝癌 ,作为治疗手段不失为一种有效的方法。     

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。     

Prophylactic portal infusion chemotherapy as adjuvant therapy for the prevention of metachronous liver metastasis in colorectal cancer

The DNA ploidy and DNA indices (DI) of 414 patients with colorectal cancer were analyzed, and the incidence of patients with metachronous liver metastasis was found to be significantly higher in those with aneuploid tumors and a DI above 1.5 than in those with aneuploid tumors and a DI below 1.4, or in those with diploid tumors and a DI equal to 1.0. Next, to confirm the effectiveness of administering prophylactic portal infusion chemotherapy (PPIC) as adjuvant therapy for the prevention of metachronous liver metastasis in colorectal cancer, a randomized controlled trial of PPIC was performed on 110 consecutive patients with primary colorectal cancer who had undergone curative resection. Although the incidence of patients with metachronous liver metastasis in the two study groups was not significantly different at 3.3% in the PPIC group and 10.3% in the control group, the incidence in the patients with aneuploidy and a DI above 1.5 was significantly lower in the PPIC group than in the control group. These findings suggest that colorectal cancer with aneuploidy and a DI above 1.5 may have a strong tendency to metastasize to the liver, and that prophylactic portal infusion chemotherapy may be effective for preventing metachronous liver metastasis in such patients.     

Surgical Therapy for Colorectal Metastases to the Liver

Colorectal cancer is the fourth most common type of cancer in the West and the second leading cause of cancer-related deaths in the United States. Approximately 35 to 55% of patients with colorectal cancer develop hepatic metastases during the course of their disease. Surgical resection of colorectal liver metastases represents the only chance at potential cure, and long-term survival can be achieved in 35 to 58% of patients after resection. The goal of hepatic resection should be to resect all metastases with negative histologic margins while preserving sufficient functional hepatic parenchyma. In patients with extensive metastatic disease who would otherwise be unresectable, ablative approaches can be used instead of or combined with hepatic resection. The use of portal vein embolization and preoperative chemotherapy may also expand the population of patients who are candidates for surgical treatment. Despite these advances, many patients still experience a recurrence after hepatic resection. More active systemic chemotherapy agents are now available and are being increasingly employed as adjuvant therapy either before or after surgery. Modern treatment of colorectal liver metastasis requires a multidisciplinary approach in an effort to increase the number of patients who may benefit from surgical treatment of colorectal cancer liver metastasis.     

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases

OBJECTIVE: To examine recurrence and survival rates for patients treated with hepatic resection only, radiofrequency ablation (RFA) plus resection or RFA only for colorectal liver metastases. SUMMARY BACKGROUND DATA: Thermal destruction techniques, particularly RFA, have been rapidly accepted into surgical practice in the last 5 years. Long-term survival data following treatment of colorectal liver metastasis using RFA with or without hepatic resection are lacking. METHODS: Data from 358 consecutive patients with colorectal liver metastases treated for cure with hepatic resection +/- RFA and 70 patients found at laparotomy to have liver-only disease but not to be candidates for potentially curative treatment were compared (1992-2002). RESULTS: Of 418 patients treated, 190 (45%) underwent resection only, 101 RFA + resection (24%), 57 RFA only (14%), and 70 laparotomy with biopsy only or arterial infusion pump placement ("chemotherapy only," 17%). RFA was used in operative candidates who could not undergo complete resection of disease. Overall recurrence was most common after RFA (84% vs. 64% RFA + resection vs. 52% resection only, P < 0.001). Liver-only recurrence after RFA was fourfold the rate after resection (44% vs. 11% of patients, P < 0.001), and true local recurrence was most common after RFA (9% of patients vs. 5% RFA + resection vs. 2% resection only, P = 0.02). Overall survival rate was highest after resection (58% at 5 years); 4-year survival after resection, RFA + resection and RFA only were 65%, 36%, and 22%, respectively (P < 0.0001). Survival for "unresectable" patients treated with RFA + resection or RFA only was greater than chemotherapy only (P = 0.0017). CONCLUSIONS: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA alone or in combination with resection for unresectable patients does not provide survival comparable to resection, and provides survival only slightly superior to nonsurgical treatment.     

转移性肝癌的治疗理念和策略

转移性肝癌是恶性肿瘤发展的终末阶段,是导致患者死亡的主要原因,其中胃肠道是常见的原发癌部位。人们正尝试通过根治转移性肝癌或控制其发展等多种治疗策略,延长患者生存期。手术治疗、全身化疗、分子靶向治疗、射频消融术、门静脉栓塞术、肝动脉导管栓塞术是转移性肝癌的有效治疗方法,其中手术治疗是转移性肝癌可能获得治愈的有效手段。相比结肠癌肝转移癌,胃癌肝转移癌的治疗正处于探索阶段,但是随着新型有效化疗药物及化疗方案的出现、肝转移癌手术适应证的拓展以及大规模多中心临床试验循证医学证据的涌现,包括胃癌肝转移在内的转移性肝癌的治疗必将朝着一个更加规范,更为有效的方向发展。