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。

Surgical Treatment for Colorectal Cancer with Hepatic Metastasis

Objective To investigate the surgical treatment for colorectal cancer with hepatic metastasis. Method 31 cases of colorectal cancer with hepatic metastasis underwent surgical treatment from August 1996 to August 2000, including synchronical resection of primary and metastasis site in 9 cases, resection of liver lesion at 6 months after surgery for colorectal cancer in 18 cases, resection of hepatic metastasis followed by primary tumor resection 2 months thereafter in 4 cases. Colorectal surgery included right colectomy in 5 cases, transverse colectomy in 4 cases, left colectomy in 7 cases, Dixon procedure in 12 cases and miles procedure in 3 cases. Hepatectomy were sorted out as left lateral lobectomy in 5 cases, left lobectomy in 2 cases, right posterior segmentectomy in 4 cases, right anterior segmentectomy in 2 cases, left or right irregular hepatectomy in 18 cases. Result No death occurred. 4 cases experienced complications, including adhesive bowel obstruction in 1 case, incision infection in 3 cases, which were cured conservatively. The 1-, 2-, 5-year survival rate were 100%, 80.6% and 29.0%, respectively according to 0.5 to 8 years follow-up in all cases. The 5 year survival rate of synchronical surgery and staging surgery were 33.3% and 27.3% respectivley. Conclusion Surgical resection is an ideal option for the hepatic metastasis from colorectal cancer if it can be indicated.