大肠癌肝转移的诊断与治疗

目的：总结大肠癌肝转移的治疗经验。方法：回顾126例大肠癌肝转移患者的临床资料。比较分析了肝转移灶切除与综合治疗两组病人的治疗效果。结果：手术切除组1，3，5年生存率分别为81.6%(31/38),44.4%(8/18）和20％（2／10），而综合治疗组分别为44.3%,21.6%和5.8%。结论：手术中B超检查对肝转移灶的定位诊断最有价值。对肝转移灶应尽可能手术切除，术后辅助化疗等综合治疗，可延长患者生存期。     

结直肠癌肝转移的诊断和治疗

目的　总结和分析结直肠癌转移的诊断和治疗。方法　回顾分析 39例结直肠癌肝转移的病人 ,通过癌胚抗原、B超CT等检查 ,提出诊断措施 ,对肝转移灶行根治性切除 6例与肝转移灶未手术仅行TACE、HAI等综合治疗 2 4例进行 3年、5年生存率比较。结果　早期诊断肝转移灶并得到根治性手术的 6例 ,3年、5年生存率分别为 6 6 .7%和 33.3% ,较未手术仅综合治疗的 2 4例的生存率 12 .5 %和 0明显增高。结论　结直肠癌肝转移应重视诊断同时根治性手术切除肝转移灶效果最佳。     

结直肠癌肝转移的手术治疗

目的 探讨手术治疗结直肠癌肝转移的疗效以及影响因素.方法 收集74例手术治疗的结直肠癌肝转移病例,进行回顾性分析.结果 本组患者3年和5年生存率分别为63.8%和49.8%.原发灶淋巴结转移者5年生存率(33.3%)显著低于无转移者(63.7%,P=0.002),脉管侵犯者(39.6%)显著低于无侵犯者(61.6%,P=0.025).转移灶个数≤3个者(53.7%)显著高于＞3个者(34.6%,P=0.021).肝转移灶局限于半肝者,其5年生存率(65.2%)显著高于双侧弥漫者(23.9%,P=0.001).结论 手术切除是唯一可能治愈结直肠癌肝转移的方法.原发灶无淋巴结转移、无脉管侵犯,转移灶个数不超过3个、局限于半肝者预后较好.     

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。     

大肠癌同时伴肝转移67例临床治疗分析

目的探讨大肠癌同时伴肝转移的外科治疗效果。方法回顾性分析2003年1月至2007年12月67例大肠癌伴肝转移经外科手术治疗的临床资料。结果13例全肝多个转移灶病人行原发病灶切除加门静脉化疗泵植入术,余54例行原发灶和肝转移灶同期切除。本组术后1、2、3年生存率分别为91．0％（61／67）、71．6％（48／67）和40．3％（27／67）。生存时间最短为8个月,最长为57个月,中位生存期为30．2个月。结论大肠癌肝转移病人行原发灶和肝转移灶同期切除辅以局部及全身化疗,亦可取得满意效果。     

大肠癌肝转移诊断和治疗体会(附69例报告)

目的总结大肠癌肝转移的诊断方法和治疗效果。方法回顾性分析我院2002年1月～2006年12月收治的69例大肠癌肝转移病人的临床资料。结果本组病例同时性肝转移癌61例(88.4%),异时性肝转移癌8例(11.6%)。血CEA增高59例(72.5%),B超检查阳性率59.4%(19/32),CT检查阳性率95.2%(40/42)。肝转移灶手术切除率17.4%。全组总的1、3、5年生存率分别为94.2%、65.2%、20.1%。结论早期诊断和治疗是提高生存率的关键,外科手术 化疗是大肠癌肝转移的重要治疗方法。     

大肠癌伴肝转移的治疗及预后因素分析:附52例报告

目的:探讨大肠癌肝转移手术切除的疗效及影响术后生存率的因素，以改进提高远期疗效的措施。 方法:对52例手术治疗的大肠癌肝转移患者进行随访，比较11例生存5年以上与41例生存5年以内的患者的临床病理资料。结果:全组术后1，3，5年生存率分别为75%，30.8%和21.2%。影响患者愈后的因素主要有：原发癌病理类型、肝转移病灶数目、手术方式及时机选择，术后治疗（均P<0.05）。结论:根治切除以及加强术后综合治疗是提高远期疗效的关键。     

大肠癌肝转移危险因素分析及其对策

目的　探讨大肠癌肝转移因素及对策。方法　对我院 1990年 1月～ 1997年 12月收治的 117例大肠癌肝转移病例 ,进行血清AFP、CEA、HBsAg、肝脏B型超声及CT检查 ,分别施行大肠癌根治、大肠癌根治加肝转移灶切除或微波固化、大肠癌姑息切除 ,大部分病例加行门静脉和区域动脉插管化疗。结果　发现肝转移多见于原发病灶位于乙状结肠 (5 5 .6 % )、有周围淋巴结转移 (76 .1% )、肿瘤超过肠腔一半 (70 .1% ) ,且直径大于 3cm(72 .6 % )、没有明显的肝硬化 (86 % )者。大肠癌根治加肝转移灶切除加门静脉和区域动脉插管化疗 ,3年、5年生存率分别达到 41.7%、2 7.8% ,对多发性肝转移灶行微波固化也能获得较满意效果。结论　进展期乙状结肠癌 ,无肝硬化病例更易发生肝转移。大肠癌根治加肝转移灶切除加门静脉和区域动脉插管化疗是较理想的治疗方法     

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.     

结直肠癌肝转移的腹腔镜微创治疗

目的:探讨腹腔镜手术治疗结直肠癌肝转移的临床疗效。方法:回顾分析2008~2014年收治的62例结直肠癌并肝转移患者的临床资料,其中15例行腹腔镜切除结直肠癌同期行肝转移癌切除(手术组),47例患者采用腹腔镜切除结直肠癌同期行肝转移癌射频消融(radio frequency ablation,RFA)。结果:手术组手术时间平均(4.6±1.1)h,术中出血量平均(610±275)ml。RFA组手术时间平均(4.1±1.3)h,术中出血量平均(410±115)ml。两组3个月肝转移癌复发率相近,约1/3,手术组1年、3年、5年生存率分别为53%、50%、50%,RFA组分别为49%、48%、45%。结论:腹腔镜结直肠癌切除同期行肝转移癌切除及射频消融术患者创伤小、康复快,手术安全、有效,可避免二期手术的创伤,延长结直肠癌晚期患者的生存时间。     

Repeat hepatic resection as effective treatment for recurrent colorectal liver metastases

Background: Approximately 20–40% of patients who undergo liver resection for colorectal metastases develop recurrent disease confined to the liver. The goals of this study were to determine whether the survival benefit of repeat hepatic resection justified the potential morbidity and mortality. Methods: A retrospective review was performed on all patients who underwent liver resection for colorectal cancer metastases between 1983 and 1995 (N=202). Repeat liver resections were performed on 23 patients for recurrent metastases. Results: There were no operative deaths in the 23 patients, and the postoperative morbidity rate was 22%. The 5-year actuarial survival rate after repeat resection was 32%, with a median length of survival of 39.9 months. There were three patients who survived for >5 years after repeat resection. Sixteen patients (70%) developed recurrent disease at a median interval of 11 months after the second resection; 10 of these 16 patients (62%) had new hepatic metastases. No clinical or pathological factors were significant in predicting long-term survival. Conclusions: Repeat liver resection for recurrent colorectal metastases (a) can be performed safely with acceptable mortality and morbidity rates and (b) may result in long-term survival in some patients.Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

结直肠癌肝转移复发再次肝切除术的疗效与预后分析

目的 探讨再次肝切除术在结直肠癌肝转移复发治疗中的应用价值.方法 回顾性分析43例结直肠癌肝转移复发再次肝切除术和67例结直肠癌肝转移复发内科化疗的临床资料.结果 结直肠癌肝转移复发再手术组和化疗组1,3,5年生存率分别为83.7％,51.1％,27.9％和65.7％,20.6％,3.0％(P＜0.05或P＜0.01).再次肝切除组无手术死亡病例,并发症发生率为32.6％.单因素分析显示肝脏复发转移灶个数,切缘情况,CEA,肿瘤大小,肿瘤分化程度与预后有关.多因素回归分析结果表明,仅有肝脏复发转移灶个数和肿瘤大小为影响预后的独立因素.结论 再次肝切除术对于结直肠癌肝转移复发是安全的治疗方案,肿瘤负荷较小(癌直径＜5 cm和转移灶＜3个)的患者预后较好;再次手术可以延长结直肠癌肝转移复发患者的生存时间.     

Survival After Hepatic Resection for Colorectal Metastases: A 10-Year Experience

Background Metastatic colorectal cancer is a major cause of cancer death in North America. Hepatic resection offers the potential for cure in selected patients. We report the long-term outcomes of patients who underwent hepatic resection for colorectal metastases over a 10-year period at a single hepatobiliary surgical oncology center. Methods All patients who underwent liver resection for metastatic colorectal cancer between 1992 and 2002 were identified. Data were retrospectively obtained through chart review. Major outcome variables were disease-free survival and overall survival. Risk factors for disease recurrence and mortality were identified by multivariate analysis by using the Cox proportional hazard method. Results A total of 423 hepatectomies were performed for metastatic colorectal cancer. Most operations (n = 276; 65%) were major (four or more segments) hepatectomies. Perioperative morbidity occurred in 74 (17%) patients. There were seven (1.6%) perioperative deaths. The disease-free survival at 1, 5, and 10 years was 64%, 27%, and 22%, respectively. The overall survival at 1, 5, and 10 years was 93%, 47%, and 28%, respectively. Multivariate analysis identified four negative predictive factors for overall survival (hazard ratio; 95% confidence interval): a positive surgical margin (2.9; 1.5–5.3), large metastases (>5 cm; 1.5; 1.1–2.0), multiple metastases (1.4; 1.1–1.9), and age >60 years (1.4; 1.1–1.9). Conclusions Hepatic resection for metastatic colorectal cancer is safe and provides good long-term overall survival rates of 47% at 5 years and 28% at 10 years. An aggressive approach is justified by the low operative mortality rate and good long-term survival, even in individuals with multiple bilobar metastases.     

What factors influence survival in patients with unresected synchronous liver metastases after resection of colorectal cancer?

OBJECTIVE: The aim of this study was to determine whether the survival of patients with untreated synchronous liver metastases after resection of a colorectal cancer was associated with any features of the primary tumour. METHODS: Information for 398 consecutive patients with unresected liver metastases in the period 1971-2001 was examined by multivariate survival analysis. RESULTS: Of 19 clinical and pathological variables considered, survival was independently associated only with residual tumour in a line of resection (hazard ratio (HR) 1.95), venous invasion (HR 1.87), right colonic tumour (HR 1.68), lymph node metastasis (HR 1.54), and extra-hepatic metastasis (HR 1.16); 8.3% of patients had none of these adverse features. Their 2-year overall survival rate was 39.2%, compared with only 16.5% (P < 0.001) in those with one or more adverse features. CONCLUSIONS: These findings may assist in selecting patients most likely to benefit from treatment of hepatic metastases and in counselling patients and their relatives.     

腹腔镜结直肠癌切除术联合射频消融治疗肝转移癌

目的 探讨腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌的临床价值.方法 2001年12月至2006年7月成都市第三人民医院对22例结直肠癌合并同时性肝转移的患者施行腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,术后通过增强CT检查评价消融灶固化效果.采用X2检验分析疗效.结果 本组22例患者中8例肝转移癌为多发,16例有合并症.对31个肝转移癌进行RFA治疗,未发生相关并发症;术后平均住院时间为(14±5)d,无手术死亡.5例因消融不完全进行重复RFA,4例消融灶复发(2例重复RFA);6例死亡(2例死于消融灶复发).消融灶复发率为18%(4/22),病死率为27%(6/22).肝转移癌直径≥2.0 cm者RFA后消融灶复发率高于直径＜2.0 cm者(x2=5.867,P＜0.05).结论 腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,为多发性肝转移癌、合并基础疾病、高龄、手术耐受差和肿瘤切除困难的结直肠癌患者提供了治疗的机会.     

结直肠癌伴同时性肝转移的治疗

目的 探讨结直肠癌伴同时性肝转移患者的临床相关病理因素以及手术治疗.方法 回顾性分析1994年8月至2006年12月收治患者的临床资料及随访结果,比较结直肠癌无肝转移和有同时性肝转移患者的病理特点及不同程度肝转移患者和不同手术处理的预后.结果 2019例原发性结直肠癌患者中发生同时性肝转移者166例(8.10%).多因素分析显示:术前CEA水平、Ducks分期、肿瘤分化程度与浆膜浸润是同时性肝转移发生的高危因素;同时性肝转移术后1、3、5年生存率分别为69%、21%、9%;不同程度肝转移(H1、H2、H3)组间预后差异有统计学意义(X2=23.35,P<0.01).根治性手术切除组总体生存率明显高于姑息切除和未能切除组生存率(X2=21.18,P<0.01);姑息切除组和未切除组近期生存率差异有统计学意义(P<0.01),远期生存率差异无统计学意义(P=0.13).结论 结直肠癌伴同时性肝转移患者肝转移程度不同预后也不同.能够根治性切除的结直肠癌伴同时性肝转移预后较好,姑息切除原发病灶可提高近期预后和生活质量.     

Hepatic resections for bilobar liver metastases from colorectal cancer

The present study was performed to assess survival benefits in patients who underwent a hepatic resection for isolated bilobar liver metastases from colorectal cancer. Thirty-eight patients underwent a curative hepatic resection for isolated colorectal liver metastasis. Among them, 11 patients had bilobar liver metastases and 19 had a solitary metastasis. The remaining 8 patients had unilobar multiple lesions. We investigated survival in two groups those with bilobar and those with solitary metastatic tumors. Survival and disease-free survival were 36% and 18% at 5 years, respectively, in the patients with bilobar liver metastases, while these survivals were 43% and 34% in the patients with solitary liver metastasis. In the 38 patients, repeated hepatic resections were performed in 15 patients with recurrent liver disease. The 5-year survival and disease-free survival rates for these patients were 38% and 27%, respectively, after the second hepatic resections. Of the 11 patients with bilobar liver metastases, 5 underwent a repeated hepatic resection, and they all survived for over 42 months. Based on our observations, a hepatic resection was thus found to be effective even in selected patients with either bilobar nodules or recurrence in the remnant liver. Received: February 7, 2000 / Accepted: April 26, 2000     

Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease

Background: Extrahepatic malignant disease has always been considered an absolute contraindication to hepatectomy for colorectal liver metastases. This study reports the long-term outcome and prognostic factors of patients undergoing extrahepatic disease resection simultaneously with hepatectomy for liver metastases.Methods: From January 1987 to January 2001, 75 patients underwent a complete R0 resection of extrahepatic disease simultaneously with hepatectomy for colorectal liver metastases. They were inscribed in a registry and then prospectively followed up. They represented 25% of the 294 patients who underwent an R0 hepatectomy for colorectal liver metastases during the same period.Results: The mortality rate was 2.7%, and morbidity was 25%. After a median follow-up of 4.9 years (range, 1.7–13.4 years), the overall 3- and 5-year survival rates were 45% and 28%, respectively. By using a Cox model, there was a significant difference in survival between patients with single versus multiple sites of extrahepatic disease. Also, the presence of more than five liver metastases was a significant parameter.Conclusions: Extrahepatic disease in colorectal cancer patients with liver metastases should no longer be considered as a contraindication to hepatectomy. However, this intended R0 resection cannot be performed in 50% of laparotomized patients, and negative prognostic factors for surgery include the presence of multiple extrahepatic disease sites or more than five liver metastases.     

大肠癌脑转移的临床特征及其手术治疗

目的 分析大肠癌脑转移的临床特征及其手术治疗转归. 方法回顾性分析手术治疗的大肠癌伴脑转移28例患者的临床资料,统计数据采用单因素Log-Rank分析和多因素Cox回归分析法.结果 大肠癌继发脑转移的中位年龄为57(41～75)岁,原发肿瘤与转移瘤间隔的中位时间为13.5个月,其中合并颅外(肺、肝、骨)转移占61%(17/28),仅有脑转移的占39%(11/28).脑转移瘤主要表现为头痛、呕吐等颅内压升高征候群和偏瘫、下肢乏力、失语等定位症状以及癫痫等,颅内转移瘤以单发病灶为多见,占82%(23/28),位于幕上(枕叶、顶叶、额叶)者占57%(16/28),位于幕下(小脑)者占43%(12/28);转移性脑瘤手术切除后中位生存时间为9.4个月,1年生存率为28.9%,5年生存率为7.1%.多因素分析提示颅内单发病灶转移(χ2=7.35,P<0.05)和无颅外其他部位转移(χ2=6.47,P<0.05)是大肠癌脑转移预后的独立影响因素.28例均接受手术切除和多学科协作治疗,无手术死亡和出血及再手术病例.结论 大肠癌脑转移总体预后欠佳,手术切除脑转移病灶可延长部分患者的存活时间.     

大肠癌脑转移的临床特征及其手术治疗

目的 分析大肠癌脑转移的临床特征及其手术治疗转归. 方法回顾性分析手术治疗的大肠癌伴脑转移28例患者的临床资料,统计数据采用单因素Log-Rank分析和多因素Cox回归分析法.结果 大肠癌继发脑转移的中位年龄为57(41～75)岁,原发肿瘤与转移瘤间隔的中位时间为13.5个月,其中合并颅外(肺、肝、骨)转移占61%(17/28),仅有脑转移的占39%(11/28).脑转移瘤主要表现为头痛、呕吐等颅内压升高征候群和偏瘫、下肢乏力、失语等定位症状以及癫痫等,颅内转移瘤以单发病灶为多见,占82%(23/28),位于幕上(枕叶、顶叶、额叶)者占57%(16/28),位于幕下(小脑)者占43%(12/28);转移性脑瘤手术切除后中位生存时间为9.4个月,1年生存率为28.9%,5年生存率为7.1%.多因素分析提示颅内单发病灶转移(χ2=7.35,P<0.05)和无颅外其他部位转移(χ2=6.47,P<0.05)是大肠癌脑转移预后的独立影响因素.28例均接受手术切除和多学科协作治疗,无手术死亡和出血及再手术病例.结论 大肠癌脑转移总体预后欠佳,手术切除脑转移病灶可延长部分患者的存活时间.