结直肠癌肝转移一期联合手术化疗的临床研究

One stage resection combined with chemotherapy for the treatment of colorectal cancer with hepatic metastasis

目的 探讨结直肠癌肝转移一期联合手术辅助化疗的有效途径及临床价值。方法回顾性分析一期联合手术切除原发癌及转移癌 ,经肝动脉门静脉双置泵栓塞灌注化疗 ,肿瘤局部注射无水酒精及热电疗法综合性治疗结直肠癌肝转移 36例的临床资料。结果 本组 36例结直肠癌患者原发癌均获切除 ,其中一期切除肝转移癌 17例 ,6例复发 ,4例再次手术切除。 19例不能切除的转移性肝癌 ,行肝动脉门静脉双置泵栓塞灌注化疗 ,无水酒精注射和热电疗法。肿瘤直径平均缩小5 7%,其中 4例因肿瘤缩小行二期手术切除。 1、2、3年生存率分别为 :切除组 94%,82 %,6 5 %;明显高于置泵组的 74%,5 3%,32 %(P <0 0 1)。结论 结直肠癌肝转移一期联合手术切除加肝动脉门静脉双置泵栓塞灌注化疗 ,是一种首选而有效的治疗方法。不能切除肝转移癌者 ,只要切除原发肿瘤 ,肝动脉门静脉置泵栓塞灌注化疗 ,可明显延长病人生存期 ,改善预后。

Objective To evaluate the effect of one stage resection combined with chemotherapy for the treatment of colorectal cancer with hepatic metastasis.Methods In this study 17 out of 36 colorectal cancer patients with hepatic metastasis underwent one stage tumor resection embolization and chemotherapy via hepatic artery and portal vein through pumps in 10 cases. The remaining 19 cases in which metastatic tumors judged as nonresectable received embolization and chemotherapy alcohol injection and electrothermotherapy for the metastatic tumors.Results Recurrence developed in 6 out of 7 patients not receiving primary combined embolization and chemotherapy. The diameter of tumors in the 19 patients decrased by 57% on average, among which 4 patients underwent secondary resection of the metastatic tumors. The 1,2,3 year′s survival rate was 94%, 82%, 65% in combined group, and 74%, 53%, 32%(P<0.01) in those not undergoing resection of the metastatic tumors.Conclusions One stage resection of the metastatic tumor combined with embolization and chemotherapy is an effective method for treating hepatic metastases from colorectal cancer.