分期手术联合射频消融和化疗栓塞治疗结肠癌肝转移12例

目的探讨分期手术联合射频消融、肝动脉化疗栓塞治疗结肠癌术后双叶肝转移的临床价值。方法 2004年12月—2007年12月我科选择性接收并采取分期手术治疗结肠癌术后双叶肝转移患者12例。Ⅰ期手术,结扎横断大多数结肠癌转移灶隶属肝叶的门静脉Ⅰ级分枝(左:右=1:11),射频消融残余肝叶内转移灶,并经胃十二指肠动脉植入肝动脉化疗泵;术后通过化疗泵行3个疗程化疗栓塞。Ⅱ期手术,全部化疗疗程结束后4周行半肝切除术。随访30月,记录术后并发症、化疗客观疗效和毒副作用、残余肝和肝外发现转移瘤时间以及实际生存时间。结果围术期内患者无死亡和肝功能衰竭,呼吸道感染/尿道感染/切口感染(2/2/2,例)是主要的术后早期并发症。患者化疗后无CR,PR 83.3%(10/12),主要不良反应为白细胞减少/血小板减少/贫血(6/3/3,例次)。2例患者术后10月残余肝内发现转移灶(超声引导下射频消融),4例患者术后17月发现肝外转移(肺2例,骨2例;立体定向R-刀治疗)。1、2年总体实际生存率分别为100%和75%,中位生存期26个月。结论分期手术联合射频消融、肝动脉化疗栓塞治疗部分结肠癌术后双叶肝转移患者近期疗效满意,不良反应可耐受,且能增加患者肝转移癌切除率、提高生活质量和生存期,是治疗结肠癌术后双叶肝转移的较好模式之一。

Efficacy of staging operation combined with radiofrequency ablation and chemo-embolization on 12 cases of hepatic metastasis from colon cancer

Objective To evaluate the efficacy of staging operation combined with radiofrequency ablation and transhepatic arterial chemoembolization on bilobar hepatic colorectal metastases post-colonectomy.Methods From December 2004 to December 2007,12 patients with bilobar hepatic colorectal metastases post-colonectomy were enrolled selectively in this group.During the stage I,ligation and transection of main portal branch on side of bulky metastases disease was performed(right branch in 11 and left in 1 patient).The metastatic nodules in the opposite lobe were ablated by radiofrequency therapy and a hepatic arterial jet port catheter was introduced via the gastroduodenal artery for liver directed chemo-embolization therapy.Three cycles of chemotherapy pumps were given via hepatic arterial infusion at intervals of 4 weeks.During the stage II,hepatic resection was carried out followed by continuation of hepatic arterial infusion of chemobiological drugs as adjuvant therapy.In the follow-up period of 30 months,all of the postoperative morbidities,the curative effect,the adverse reaction,recurrent tumors in remaining liver,extrahepatic metastatic nodules and life span were recorded.Results Within double of perioperations,neither hepatic failure nor death was noted.Early morbidities were 2 patients respectively in the inflammatory form of respiratory tract,urinary tract and wound.The hematological toxicities were in the form of leucopenia(6 cases),thrombocytopenia(3 cases) and anemia(3 cases) however they never exceeded WHO grade II.83.3% PR and none of CR were observed.Two patients developed hepatic recurrence within 10 months which were ablated by radiofrequency therapy and four patients were detected extra-hepatic metastases within 17 months(2 in lung and 2 in bones) which were treated with Gamma-ray Stereotactic Radiotherapy.There was 100% one-year survival and 75.0% two-year survival observed.In the follow-up period of 30 months,a mean survival of 26 months was noted.Conclusion The staging operation combined with radiofrequency ablation and transhepatic arterial chemoembolization is one of the preferable methods which howed good short term effect,can increase the resectability rate,prolong overall survival and improve quality of the life of the patients with advanced bilobar hepatic colorectal metastases post-colonectomy.The adverse reactions can be tolerated.