结直肠癌肝转移的外科治疗

Surgical treatment of colorectal cancer with hepatic metastasis

目的 探讨结、直肠癌肝转移的外科治疗。方法 对１９９３ 年１ 月至１９９９ 年１ 月的１９ 例结、直肠癌肝转移患者行外科治疗。其中６ 例同期切除，１０ 例分期切除，１ 例肝动脉结扎加无水乙醇注射，２ 例通过肝动脉结扎加化学药物治疗（化疗） 泵灌注化疗而获得二期手术切除机会。手术方式行肝不规则楔形切除１６ 例，左半肝切除２ 例。结果 术后１、３、５ 年生存率分别为８９％ 、５８％ 、２１％ 。６ 例同期肝切除者平均生存期２３ 个月，１０ 例分期肝切除者的平均生存期为３２ 个月。结论 掌握手术时机和适应证，积极进行肝动脉灌注化疗，提高手术切除成功率是提高存活率的关键。

Objective To investigate the optimal surgical treatment of colorectal cancer with hepatic metastasis. Methods From January 1993 to January 1999 ,19 cases of colorectal cancer with hepatic metastasis were collected .In 6 patients colorectal cancers together with hepatic metastases were resected atthe sametime.In 10 patients second stage resections ofhepatic metastases were performed after resection of primary tumors,one patient had hepatic artery ligated and anhydrous alcohol injected into tumors,2 patients had hepatic artery ligated and received chemotherapy by hepatic arterialinfusion before second stage resection . Wedge resections were performed in 16 patients and left lobotomy in 2 patients. Results The 1 ,3 ,5 yearsurvivalrates were89 % ,58 % ,and 21 % .The mean survivaltime was23 months in 6 cases of simultaneous hepatic resection and 32 months in 10 cases of second stage resection . Conclusion Itisthe keytoimprovethe survivalratethatincreasessuccessfulrate ofsecond stageresection by masteringthe opportunity andindication ofoperation and givesa positive chemotherapy by hepaticarterial infusion.