术中超声辅助肝切除联合射频消融根治性治疗双叶弥散性结直肠癌肝转移

Intraoperative ultrasonographically guided hepatectomy combined with RFA for hepatic multiple bilobar colorectal metastases

目的探索术中超声辅助下肝切除联合射频消融根治性治疗双叶弥散性结直肠癌肝转移的安全性和可行性。方法 2006年1月至2012年1月期间,5例被2名以上专家判断失去手术时机的双叶弥散性结直肠癌肝转移患者,成功实施根治性治疗。其中男2例,女3例。平均年龄57岁(44～65岁)。回顾性分析其手术相关临床指标。结果术中超声发现肝脏转移病灶平均20.4个(15～28个),围手术期死亡0例,肝功能衰竭0例。围手术并发症:腹腔感染1例,大量腹水2例,胸腔积液4例。术后1个月影像学检查和血清CEA等证实达到根治性治疗。结论术中超声辅助下一期肝切除联合射频消融治疗是双叶弥散性结直肠癌肝转移治疗的一种很好的选择,可以提高转移性肝癌的切除率。

Objective To explore the safety and efficacy of hepatectomy combined with RFA by intraoperative ultrasonographically guide in patients with multiple bilobar colorectal metastases. Methods Between January 2005 and January 2012, 5 patients with unresectable hepatic multiple bilobar coloreetal metastases, diagnosed by more than 2 experts, underwent hepatectomy combined with RFA by intraoperative uhrasonographically guide. In the 5 patients 2 were male and 3 female with a mean age of 57 years （ranging from 44 to 65 years）, and clinical data of the patients were analyzed retrospectively. Results The average number of metastases was 20.4 （ 15 - 28 lesions）. There was no perioperative death or hepatic failure. Four patients （80%） had pleura] effusion, 2 had aseites （40%）, and 1 had abdomen infection （20%）. Radical operations were confirmed by radiographic inspection and serous CEA test. Conclusions The operative procedure of intraoperative uhrasonographical guide is a good alternative for patients with multiple bilobar colorectal metastases.