198例结直肠癌肝转移患者外科治疗的疗效分析

背景与目的:肝脏是结直肠癌常见的转移部位,35%的患者在确诊时已发生肝转移,肝转移患者的预后较差。尽管手术切除、化疗、射频消融术、介入治疗等手段应用于临床,但治疗效果不同。本研究探讨结直肠癌肝转移外科治疗的临床疗效。方法:对我院5年间经病理检查证实的198例结直肠癌肝转移患者的临床资料进行回顾性分析。根据治疗方法的不同进行分组:根治性切除组46例(23.2%)、姑息性切除组43例(21.7%)、手术探查组或最佳支持治疗组29例(14.6%)、肝动脉置泵化疗组41例(20.7%),全身化疗组39例(19.7%);对其生存期进行比较和统计学分析。结果:根治性切除组中位生存期37.1个月,5年生存率为31.2%;姑息性切除组的中位生存期14.3个月,5年生存率为0;肝动脉置泵化疗组的中位生存期21.3个月,5年生存期为7.5%;全身性化疗和探查组或最佳支持治疗组的中位生存期分别为18.7个月、6.3个月,均无5年生存者。根治性切除组与其他组比较,中位生存期有统计学意义(P<0.01)。结论:根治性切除是提高结直肠癌肝转移患者生存率的重要手段;姑息性切除治疗效果并不优于辅助性治疗,对于不能根治性切除的病例可采用肝动脉置泵化疗。

Treatment efficacy of surgical management for liver metastasis from colorectal cancer--a report of 198 cases

BACKGROUND & OBJECTIVE: Liver is the most common site of metastasis in colorectal cancer, and 35% patients with colorectal cancer developed liver metastasis at diagnosis. The prognosis of the patients with liver metastases from colorectal cancer is poor. Surgical resection, radiofrequency ablation, and chemotherapy had been used in clinical treatment for liver metastasis from colorectal cancer with various outcomes. This study was to explore the treatment efficacy of surgical management for liver metastasis from colorectal cancer. METHODS: Clinical data of 198 patients with liver metastasis from colorectal cancer, treated from Jan. 1995 to Jan. 2000, were studied retrospectively. Of the 198 patients, 46 (23.2%) received radical resection, 43 (21.7%) received palliative resection, 29 (14.6%) received exploratory operation or supportive treatment, 41 (20.7%) received adjuvant hepatic arterial infusion, and 39 (19.7%) received adjuvant systemic chemotherapy. Survival statuses of the patients in different groups were compared. RESULTS: The median survival time of radical resection group was significantly longer than those of palliative resection group, exploratory operation or supportive treatment group, adjuvant hepatic arterial infusion group, and adjuvant systemic chemotherapy group (37.1 months vs. 14.3, 6.3, 21.3, and 18.7 months, P<0.01). The 5-year survival rates of the 5 groups were 31.2%, 0, 0, 7.5%, and 0, respectively. CONCLUSIONS: Radical resection could improve survival of the patients with liver metastasis from colorectal cancer. Palliative resection has no advantage over adjuvant therapy. Adjuvant hepatic arterial infusion should be applied in the unresectable cases.