结直肠癌术后肝脏尾状叶转移瘤的手术切除(附18例报告)

目的探讨结直肠癌术后肝脏尾状叶转移性肿瘤的手术切除方法及疗效。方法回顾性分析海军总医院肝胆外科1999年1月-2007年1月施行肝切除的尾状叶结直肠癌术后转移性肿瘤的手术情况及治疗效果。结果共切除肝脏尾状叶转移癌18例,肿瘤直径为3.2~11.3cm,平均6.3cm;肝切除术式包括单独尾状叶全切除6例,全尾状叶合并其他肝叶切除9例,部分尾状叶切除3例;手术持续时间为154~360min,平均198min,术中失血量为400~3250ml,平均975ml,全组无手术死亡病例,发生明显并发症者5例(27.8%);全组术后随访1、3、5年生存率分别为83.3%、61.1%和27.8%。结论结直肠癌术后肝脏尾状叶转移性肿瘤可累及3个肝门,手术切除虽较为困难,但仍是首选的治疗方法。

Post-operational surger of colorectal cancer for metastatic tumor on caudate lobe of liver:report of 18 cases

Objective To evaluate the techniques and effects of post-operational surgery of colorectal cancer for metastatic tumor on caudate lobe of liver. Methods For the patients admitted from Jan. 1999 to Jan. 2007 to the Navy General Hospital of PLA and undergone metastasectomy on caudate lobe of liver after colorectal cancer operation, the operative procedure and effects were studied retrospectively. Results A total of 18 cases of metastasectomy on caudate lobe of liver were successfully performed. The mean diameter of the metastases was 6.3cm (3.2-11.3cm). The types of operation included total caudate lobectomy (6 cases), total caudate lobectomy combined with extended hepatectomy (9 cases) and partial caudate lobectomy (3 cases). The mean operative time was 198min (154-360min) and the average intraoperative blood loss was 975ml (400-3250ml). No intraoperative death occurred, while the remarkable complications were found in 5 cases (27.8%). The survival rates of follow up for 1, 3 and 5 years were 83.3%, 61.1% and 27.8%, respectively. Conclusions The metastases on caudate lobe of liver after colorectal carcinoma resection usually involve all the hepatic portals. Surgical resection, though sophisticated in technique, remains to be a safe and effective treatment, and the first choice for treating metastases.