手术切除联合术中氩氦刀冷冻和无水乙醇注射治疗结直肠癌多发性肝转移

Hepatectomy combined with cryoablation and ethanol injection for unresectable multiple liver metastases from colorectai cancer

目的探讨手术切除联合术中氩氦刀冷冻和无水乙醇注射治疗结直肠癌多发性肝转移的疗效与安全性。方法回顾性分析2005年1月至2010年12月间在广州医学院附属肿瘤医院胃肠肿瘤外科接受手术切除联合术中B超引导下氩氦刀冷冻消融和无水乙醇注射的23例无法完全切除的结直肠癌多发性肝转移患者的临床和随访资料。结果本组23例患者男15例，女8例．年龄34-69（平均52．2）岁。23例患者均顺利完成治疗，98个肝转移灶中，经手术切除45个，经氩氦刀联合无水乙醇注射处理53个。肝转移灶手术时间27-96min．术中出血量50～450ml。无围手术期死亡病例：术后出现少量胸腔积液和肌红蛋白尿各1例。所有患者均接受了8～70（中位时间34）个月的术后随访，1、3、5年总体生存率分别为83．2％、45．5％和37．6％。结论对于无法完全切除的结直肠癌多发性肝转移，采用手术切除联合术中氩氦刀冷冻和无水乙醇注射治疗安全有效。

Objective To evaluate the efficacy and safety of hepatectomy combined with cryoablation and ethanol injection in patients with unresectable multiple liver metastases from colorectal cancer. Methods Clinical data of 23 patients with multiple liver metastases form colorectal cancer in the Affiliated Tumor Hospital of Guangzhou Medical College between January 2005 and December 2010 were analyzed retrospectively. There were 15 males and 8 females with average age of 52.2 years. All the patients underwent hepateetomy combined with ultrasound-guided cryoablation and ethanol injection intraoperatively. Results Among 98 lesions in 23 patients, 45 were removed intraoperatively and 53 were treated by cryoablation and ethanol injection. Operative time for liver lesions ranged from 27 to 96 minutes and intraoperative blood loss 50 to 450 ml. One patient developed pleural effusion and 1 myoglobinuria after operation. All the patients were followed up with a median follow-up time of 34 months （8 to 70 months）. The 1-, 3-, and 5-year survival rates were 83.2%, 45.5% and 37.6% respectively. Conclusion Hepateetomy combined with cryoablation and ethanol injection is an effective and safe treatment option for patients with unresectable multiple liver metastases from colorectal cancer.