门静脉插管皮下置泵术在结肠癌肝转移中的应用

Application of portal vein catheterization and subcutaneous placement of chemotherapy pump for the treatment of liver metastasis of colon carcinoma

目的:评价在结、直肠癌肝转移的患者中进行门静脉插管皮下置泵术的治疗意义。方法:应用门静脉插管皮下置泵术治疗结、直肠癌肝转移患者23例,于手术切除原发肿瘤的同时经门静脉插入导管,导管的另一端经腹壁至皮下与药泵相连。术后定期微泵化疗。静脉组21例,经外周静脉化疗。结果:插管组:根治术后18例,3年无瘤生存率为69.1%,肝转移及腹膜复发率分别为12.8%和6.0%,5例姑息术后平均生存期为14个月。静脉组:根治术后16例,3年无瘤生存率为53.0%,肝转移及腹膜复发率分别为18.0%和28.0%,5例姑息术后平均生存期为10个月。结论:手术中行肠系膜动脉插管操作方法简单,术后给药方便,且并发症少。此方法对Dukes′B、C期根治术者,有提高术后3年无瘤生存率和降低术后肝转移及腹膜复发率的作用;对Dukes′D期姑息手术者,有延长生存期的作用。是一种有效的辅助治疗手段。

Objective： To evaluate portal vein catheterization and subcutaneous placement of chemotherapy pump for the treatment of liver metastasis of colorectal carcinoma. Methods： Forty-four patients with liver metastasis of colorectal carcinoma were divided into group A（n = 23） and group B（n = 21 ） and underwent different methods of treatment. 23 patients with liver metastasis of colorectal carcinoma in group A were treated with resection of primary lesion of carcinoma and portal vein catheterization and subcutaneous placement of chemotherapy pump for ensuing treatment. One end of the tube was installed in the portal vein and the other end connected with the subcutaneous placed chemotherapy pump. Chemotherapy was done regularly after operation. 21 patients with liver metastasis of colorectal carcinoma in group B were treated with resection of primary lesion of carcinoma and postoperative chemotherapy through peripheral vein. Results： Of the patients in group A, 18 cases underwent radical operation, 3 years survival rate without tumor was 69.1%, recurrent rates of liver and peritoneal metastasis were 12.8% and 6.0% respectively; 5 cases had palliative operation and survived 14 months on average. Of the patients in group B, 16 cases underwent radical operation, 3 years survival rate without tumor was 53.0%, recurrent rates of liver and peritoneal metastasis were 18.0% and 28.0% respectively; 5 cases had palliative operation and survived 10 months on average. Conclusion： It＇s simple to practice portal vein catheterization during operation, which is convenient for postoperative therapy and has less complication. Portal vein catheterization and subcu- taneous placement of chemotherapy pump for the treatment of liver metastasis of colon carcinoma can increase survival rate without tumor of patients with Dukes stage B, C colorectal carcinoma, decrease liver and peritoneal metastasis; for patients with Dukes stage D colorectal carcinoma undergoing palliative operation, it can lengthen survival time. It＇s an effective adjuvant means for the therapy of colorectal carcinoma.