手术切除在结直肠癌肝转移治疗中的意义及预后

目的 探讨手术切除对结直肠癌肝转移的疗效及预后影响因素.方法 回顾性分析施行肝切除术的35例结直肠癌肝转移患者的临床及随访资料.Kaplane-Meier法分析生存率.多因素预后分析采用Cox逐步回归法.结果 全组总的1、3和5年累计生存率分别为93.5%、68.5%和39.9%.单因素分析显示转移瘤最大直径、手术切缘、淋巴结转移、肝转移类型及转移瘤病理分化程度对生存率有显著影响;多因素分析显示肝转移瘤最大直径(P=0.012)、手术切缘(P=0.027)是影响生存率的独立因素.结论 结直肠癌肝转移的外科治疗可使患者获得长期生存.最大转移瘤直径小于5.0cm、手术切缘阴性预示结直肠癌肝转移手术切除预后较好.

Surgical treatment and prognosis of colorectal liver metastases

Objective To evaluate the curative effect and prognosis of hepatic resection for colorectal liver metastases(CLM).Methods Thirty-five cases of CLM were treated with hepatectomy from Jan.1999 to Feb.2006.Clinical and follow-up data of these cases were analyzed retrospectively.The cumulative survival rate was analyzed by Kaplane-Meier method.Multiple factor analysis was introduced by Cox's proportional hazard model.Results The survival rates of overall 1-,3-,and 5-year were 93.5%,68.5% and 39.9%,respectively.According to univariate analysis,the survival rate was affected by tumor size,surgical margin,lymphatic metastasis,type of liver metastases,metastatic carcinoma differentiation significantly(P<0.05).Multiple factor analysis revealed that tumor size(P=0.012),incisal margin(P=0.027)were independent factors on survival rate.Conclusions Hepatectomy can prolong survival time of patients with CLM.Either tumor size of <5cm or negative incisal margin predicts a better survival.