结直肠癌肝转移的手术治疗及预后分析

Prognostic analysis of surgical resection for patients with liver metastases from colorectal carcinoma

目的探讨结直肠癌肝转移患者手术治疗的指征、相关病理因素及手术治疗对预后的影响。方法回顾性分析本院2000年1月至2007年12月间经手术治疗的75例结直肠癌肝转移患者的临床资料。结果本组同时性肝转移62例，异时性肝转移13例，均在结直肠癌原发灶根治性切除基础上，行肝叶规则或不规则切除70例，结节切除活检5例。术后出现并发症10例。术后1年，3年，5年累积生存率分别为74．67％，58．67％，28．00％。生存分析显示：肝切除术后的生存率与原发灶的分化程度、术前CEA、Duke’s分期、肝转移数目、组织分型及淋巴结受侵有关。结论临床病理分期早，肿瘤分化程度高，转移灶数目≤2．术前CEA水平低的患者预后好：手术治疗是结直肠癌肝转移的首选治疗方法。

Objective To assess the indication and efficacy of surgical treatment for patients with hepatic metastases from colorectal carcinoma. Methods Clinical data of 75 patients with hepatic metastases from colorectal carcinoma undergoing surgery from January 2000 to December 2007 were analyzed retrospectively. Re~ suits Among 75 patients,52 patients were found to have synchronous hepatic metastasis and 13 patients were found to have metachronous hepatic metastases. 70 patients underwent resection of hepatic metastases and complications occurred in 10 patients. The 1,3 and 5-year survival rates were 74. 67%, 58.67% and 28.00% respatectomy. Univariate analysis revealed that solitary metastasis was a significant factor for favorable prognosis after surgery . The expression of preoperative CEA, Dukes stage, the number of hepatic metastases, status of lymph node metastasis and histological differentiation of the primary colorectal carcinoma were all significant factors for prognosis after surgery. Conclusion The hepatic metastases from colorectal cancer should be treated by a surgical approach. T earlier stage of clinical pathology, higher differentiation extent, metastases less than 2, and low-level expression of preoperative CEA predict a better survival.