大肠癌肝转移的外科治疗

SURGICAL TREATMENT OF HEPATIC METASTASES FROM LARGE BOWEL CARCINOMA

目的：总结和分析大肠癌肝转移的早期诊断和手术治疗。方法：通过对大肠癌肝转移病例进行回顾性分析．并结合文献对有关大肠癌的早期诊断及外科手术切除治疗等相关问题进行讨论。结果：①１８例中，依靠ＣＴ、“Ｂ”超及ＣＥＡ定量检测获得诊断者１０例，术中探查获得诊断者８例。②手术方式分为肝段切除、肝楔形切除及肿瘤剜出术。③１８例中生存５年者２例，生存４年者３例．生存３年者５例，生存２年者５例，生存１年者３例。①无手术死亡病例，术中肝后段下腔静脉大出血１例，术后切口脂肪液化１例。结论：早期大肠癌肝转移的诊断中要依靠术中仔细对肝脏的探查，“Ｂ”超、ＣＴ等影像学随访及ＣＥＡ的定量随访监测。目前手术治疗是大肠癌肝转移最有效的治疗方法．主流术式应为不规则肝切除，切缘距肿瘤＞１．０ ｃｍ为大肠癌肝转移的根治性切除术。肿瘤切除术后大肠癌肝转移病例能获得良好的结果。

Objective: To analyze and evaluate the early diagnosis and surgical treatment of the liver metastases from large bowel cancer. Methods:Retrospetive analysis was made on cases of liv- er metastasis of colorectal cancer admitted into our center. Results: ①10 out of 18 cases liver metastases of large bowel cancer were proved by CEA, CT scan and B-ultrasonography, and the rest diagnosised by exploring operation; ② Operating modes includes liver segment resection, wedge-shaped resection, and tumor scooping out, ③ all cases recovered smoothly after opera- tion. The 1-, 2-, 3-, 4-, 5-year survival cases were 3. 5, 5, 3, 2, respectively. One case had massive hemorrhage in operation, 1 case incision fat liquity. Conclusion: Early diagnosis of liver mestastasis of large bowel carcinoma, mainly depends on prognosis of CT scan, CEA and B-ultra- sonography and exploring operation. The prevalent procedure to deal with the liver secondary tu- mor is irregular liver rescetion. Radical hepatic resection (margin≥1. 0 cm ) is a very useful treat- ment for liver metastases from colorectal cancer.