结直肠癌肝转移病人手术切除肝转移灶价值分析

LIVER RESECTION FOR PATIENTS WITH LIVER METASTSES FROM COLORECTAL CARCINOMA:A VALUE ANALYSIS

目的评价结直肠癌肝转移病人手术切除肝转移灶的价值。方法联合检索万方数据知识服务平台和维普期刊资源整合服务平台2007年1月—2012年9月关于结直肠癌肝转移手术治疗文献,并将文献中的治疗方案分为同期手术切除原发灶+肝转移灶组(A组)、手术切除原发灶+二期切除肝转移灶组(B组)、单独切除原发灶+术后介入治疗组(C组)、单纯手术切除原发灶组(D组)及非手术治疗组(E组)5组,比较各组3年或5年生存率。结果 A组5年生存率与B组比较差异无显著性(P>0.05),A组与C、D、E组5年生存率比较差异有显著性(χ2=8.158～22.130,P<0.05);C组与D、E组3年生存率比较差异有显著性(χ2=4.117、8.295,P<0.05)。结论对于可以切除肝转移灶的结直肠癌肝转移病人,手术切除原发灶及肝转移灶是首选的治疗方案。另外,二期行手术切除肝转移灶也是可以选择的。对于手术可以切除原发灶而不能切除肝转移灶的病人,手术切除原发灶后行介入治疗,可以改善预后并提高生存率。

Objective To assess the value of liver resection for patients with liver metastases from coloreeta[ carcinoma. Methods By employing federal search system of Wanfang data service and CQVIP, the literatures on surgery of liver metastases （published during 2007.01--2012.09） were reviewed and collected. According to the literature retrieval, treatment protocols were divided into five groups as follows： group A-liver resection synchronous with eolorectal surgery; group B-colorectal surgery plus secondary metastasis resection; group C-colorectal surgery only plus postoperative interventional therapy; group D^merely eolorec- tal surgery; and group E-non operative therapy. Three-year and five year survival were compared among each group. Results There was no significant difference between group A and group B in terms of five-year survival rate, but the difference of five-year survival between group A and groups C, D and E was significant （%2--8.158--22.130,P〈0.05）. With regard to three-year survi- val, the difference between group C and groups D and E was significant （x2 =4.117,8.295;P〈0.05）. Conclusion For patients with resectable liver metastases from eolorectal carcinoma, resection of primary disease and liver metastasis is the first-choice the- rapy, otherwise, secondary liver resection is elective; for those with resectable primary disease, but unresectable liver metastasis, interventional therapy after removal of the primary tumor may improve patients＇ prognosis and raise their survival rate.