结直肠癌肝转移的手术治疗

Surgical treatment of liver metastases from colorectal cancer

目的 探讨手术治疗结直肠癌肝转移的疗效以及影响因素.方法 收集74例手术治疗的结直肠癌肝转移病例,进行回顾性分析.结果 本组患者3年和5年生存率分别为63.8%和49.8%.原发灶淋巴结转移者5年生存率（33.3%）显著低于无转移者（63.7%,P=0.002）,脉管侵犯者（39.6%）显著低于无侵犯者（61.6%,P=0.025）.转移灶个数≤3个者（53.7%）显著高于＞3个者（34.6%,P=0.021）.肝转移灶局限于半肝者,其5年生存率（65.2%）显著高于双侧弥漫者（23.9%,P=0.001）.结论 手术切除是唯一可能治愈结直肠癌肝转移的方法.原发灶无淋巴结转移、无脉管侵犯,转移灶个数不超过3个、局限于半肝者预后较好.

Objective To assess the efficacy and influencing factors of surgical treatment of liver metastases from colorcctal cancer. Methods The clinical data of 74 patients who underwent hepatectomy for colorectal liver metastases were collected and analyzed retrospectively. Results The 3 - and 5 - year survival rate after hepatectomy for metastases was 63.8% and 49.8% ,respectively. The 5 - year survival rate was significantly lower in patients with lymph node metastases from the primary site than that without metastases （33.3% vs 63.7% ,P = 0. 002）. Survival rate in patients with microvessel invasion from the primary tumor was also significantly lower than that without invasion （39.6% vs 61.6% , P = 0.025）. Patients with metastases 〈 or = 3 had longer 5 - year survival （53.7%） than that 〉 3 （34.6% ,P =0. 021 ）. The survival in patients who had metastases isolated to half liver was longer than that in patients who had diffused metastases （65.2% vs 23.9% ,P = 0. 001 ）. Conclusion Surgical re- section may be the only treatment modality for the cure of colorectal liver metastases. Without lymph node metastases and microvessel invasion from the primary tumor,and metastases 〈 or = 3 and isolated to half liver are associated with better prognosis.