结直肠癌肝转移综合介入治疗的临床应用

Clinical application of multimodality interventional therapy in liver metastases of colorectal cancer

目的:探讨介入治疗结直肠癌肝转移(colorectal liver metastases,CLM)的临床疗效。方法:将77例无法手术切除或切除不完全的CLM分为2组,治疗组39例先行TACE,1周后在CT引导下行瘤体内注射无水乙醇,然后注入超液化碘油与丝裂霉素+阿霉素混合乳剂适量。对照组38例仅行TACE。结果:治疗组CR 4例(10.2%),PR 34例(87.2%),有效率(CR+PR)97.4%,中位生存期为42个月,1年、3年、5年生存率分别为91.7%、45.8%、31.3%。对照组CR 1例(2.6%),PR28例(73.7%),有效率(CR+PR)76.3%,中位生存期为23个月,1年、3年、5年生存率分别为71.0%、22.6%、9.6%。治疗组明显高于对照组,差异有统计学意义(P<0.05)。无严重并发症发生。结论:介入治疗是不能根治性切除的肝转移瘤患者的有效治疗方法,综合性介入治疗的有效率和生存率明显优于单纯肝动脉化疗栓塞。

Objective： To investigate the clinical curative effect of interventional therapy for liver metastasis of colorectal cancer. Methods： 77 cases of no operation excision or incomplete resection of colorectal cancer with liver metastases were divided into 2 groups. The treatment group of 39 cases had hepatic artery chemotherapy embolism in advance, then had intratumoral injection of anhydrous ethanol 1 week later in CT guided, and were injected lipiodol with mitomycin C＋doxorubicin hybrid e mulsion. 38 cases of the control group only received hepatic arterial infusion chemotherapy and embolization. Results： In treat- ment group, CR 4 cases （10.2%）, PR 34 cases （87.2%）, efficiency （CR＋PR） of 97.4%, the median survival time was 42 months. And 1 year,3 years,5 years survival rates were 91.7%, 45.8%, 31.3%, respectively. In control group, CR 1 case （2.6%）, PR 28 cases （73.7%）, efficiency （CR＋PR） of 76.3%, the median survival time was 23 months. And 1 year, 3 years, 5 years survival rates were 71.0%, 22.6%, 9.6%, respectively. The treatment group was significantly higher than that in the control group, there was significant difference （ P 〈0. 05）. No serious complications occurred. Conclusion： Inter- ventional treatment is an effective method in patients with not curative resection of liver metastases. The efficiency and survival rate of comprehensive interventional treatment is significantly better than that of hepatic artery chemotherapy embolization.