同期手术治疗胃及结直肠肿瘤伴肝转移28例临床分析

目的探讨胃及结直肠肿瘤合并肝转移患者的手术治疗效果。方法 2008年1月至2012年12月,32例伴肝转移的胃及结直肠肿瘤收治入院。对患者进行手术耐受性、手术切除可能性及手术风险评估。对于有手术指证并愿意接受手术的28例患者行手术治疗。胃肠道肿瘤根治术及肝转移灶切除术15例(其中2例行化疗泵植入术),胃及结直肠肿瘤切除术7例(其中2例行化疗泵植入术),胃空肠吻合术1例,结肠侧侧吻合术4例(其中行化疗泵植入术2例),剖腹探查化疗泵植入术1例。术后化疗6个月,并终身随访。结果无手术死亡,术后3例出现腹腔积液,经置管引流后恢复良好,1例术后一周出现吻合口漏,予灌注冲洗低压持续引流两周后痊愈。术后肺部感染6例经抗感染治疗后痊愈,1例术后出现腹腔感染,经抗炎治疗后痊愈。一年生存率82.1%,两年生存率42.9%,三年生存率25%。结论胃肠道肿瘤合并肝转移并非手术绝对禁忌证,选择合适的患者,采取积极的外科手术治疗,可以获得较好的疗效。

Operation for the patients of gastric or colorectal carcinoma with liver metastasis

Objective To investigate the effects of operation with the patients who suffered from gastric or eolorectal carcinoma with liver metastasis. Methods From January 2008 to December 2012, 32 cases of gastric or colorectal carcinoma with liver metastasis admitted in our department were included. The Surgery tolerance of the patients and the possibility of surgical resection of these patients was assessed. Among which 28 patients who with surgical indications were underwent surgery. All of them were performed chemotherapy and did follow-up evaluation. Results 28 cases in this group were performed surgery and 15 cases of which were performed resection of gastrointestinal carcinoma and liver metastasis（ injection instrument was implanted in 2 cases）, and 7 cases were underwent gastrointestinal carcinoma resection only （injection instrument was implanted in 2 cases. Gastrojejunostomy was performed in 1 case. 4 cases were performed colocolic anastomosis（ injection instrument implanted in 2 cases）. Exploratory laparotomy and subcutaneous implantable pump was clone in 1 case. All of them survived after surgery. Pyoperitoneum occurred in 3 cases which were healed by draining. Anastomotic leakage occurred in 1 case which healed by lavation cleaning for two weeks. Pulmonary infection was occurred in 6 cases while abdominal infection occurred in 1 case which were healed by anti-infective therapy. One, two and three year survival rate were 82.1%, 42.9% and 25%, respectively. Conclusion Gastric or colorectal carcinoma with liver metastasis were not the contraindication of surgery. Preferably outcome was obtained after surgery in appropriate ea- ses.