多学科团队在结直肠癌肝转移诊治中的临床应用

Clinical application of the multidisciplinary team in the diagnosis and treatment of colorectal liver metastasis

目的分析和研究多学科管理(MDT)在结直肠癌肝转移(CLMs)治疗中的临床应用效果。方法选取2014年1月~2017年4月广东省惠州市第一人民医院收治的42例CLMs患者作为研究对象,使用随机数字表法将其分为对照组和观察组,每组各21例。对照组患者未经MDT讨论,观察组患者通过多学科团队合作进行诊治。比较两组患者的术前化疗率、化疗完成转化率、手术情况及死亡率。结果观察组患者的术前化疗率和化疗完成转化率分别为95.23%和80.95%;高于对照组的58.33%和53.33%,差异有统计学意义(P<0.05)。观察组患者的一期切除或消融术发生率为76.92%,高于对照组的27.58%,差异有统计学意义(P<0.05)。观察组患者的转移灶手术切除率为75.00%,高于对照组的33.33%,差异有统计学意义(P<0.05)。两组患者的R0切除率、淋巴结清扫率、转移灶清扫率、病理完全缓解率比较,差异无统计学意义(P>0.05)。观察组和对照组患者的1年随诊死亡率分别为4.76%(1/21)和9.52%(2/21),两组患者的1年随诊死亡率比较,差异无统计学意义(P>0.05)。观察组患者的2年随诊死亡率为38.09%(8/21),低于对照组的61.90%(13/21),差异有统计学意义(P<0.05)。结论MDT模式下多种方法序贯治疗CLMs患者疗效确切,有利于规范患者术前检查和术期化疗,对于提高患者切除、消融术率和转移灶手术切除率作用明显,值得临床推广应用。

Objective To analyze and study the clinical application effect of multidisciplinary management(MDT)in the treatment of colorectal liver metastasis(CLMs).Methods A total of 42 patients with CLMs who treated in the First People′s Hospital of Huizhou City,Guangdong Province from January 2014 to April 2017 were selected as the research objects and divided into the control group and the observation group by random number table method,with 21 cases in each group.The control group was not achieved MDT,while the observation group was carried out multidisciplinary teamwork for diagnosis and treatment.The preoperative chemotherapy rate,chemotherapy completion conversion rate,surgical conditions and mortality rates of the two groups were compared.Results The preoperative chemotherapy rate and chemotherapy completion conversion rate of the observation group(95.23%,80.95%)were higher than those of the control group(58.33%,53.33%),and the differences were statistically significant(P<0.05).The proportion of primary resection or ablation in the observation group(76.92%)was higher than that of the control group(27.58%),and the difference was statistically significant(P<0.05).The surgical resection rate of metastases in the observation group(75.00%)was higher than that in the control group(33.33%),and the difference was statistically significant(P<0.05).There were no statistically significant differences in R0 resection rate,lymph node dissection rate,metastasis dissection rate and pathological complete remission rate between the two groups(P>0.05).The 1-year follow-up mortality rate of the observation group and the control group were 4.76%(1/21)and 9.52%(2/21).There was no statistically significant difference in the 1-year follow-up mortality rate between the two groups(P>0.05).The 2-year follow-up mortality rate of the observation group and the control group were 38.09%(8/21)and 61.90%(13/21).The 2-year follow-up mortality rate of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The MDT model of multiple methods for sequential treatment of CLMs obtains a definite effect,which is conducive to standarde patient′s preoperative examination and intraoperative chemotherapy,and has a remarkable effect on improving the resection and ablation rate and the resection rate of metastases.It is worthy of clinical promotion and application.