论文部分内容阅读
目的评价手术治疗结直肠癌肝转移的疗效。方法分析复旦大学附属中山医院2000年1月1日至2005年12月31日收治的470例结直肠癌肝转移患者的资料,评价手术治疗对其生存的影响。结果 196例同时性肝转移患者中手术30例(15.3%),274例异时性肝转移患者中手术103例(37.6%)。同时性肝转移组手术死亡率(3.3%)高于异时性肝转移组(1.9%)(P<0.05)。以2006年6月31日为随访终点,随访率100%,手术患者中同时性肝转移组1、3、5年生存率和中位生存时间与异时性肝转移组相似(P>0.05),但术后复发率较高(36.7%比20.4%,P=0.030)。49例具有手术指征而未手术的患者其1、3、5年生存率明显低于手术患者(P=0.003)。同时性肝转移组中22例Ⅰ期手术切除原发灶和肝转移灶和8例Ⅱ期手术患者的1、2、3年生存率和中位生存时间相似(P>0.05)。生存因素风险分析发现手术切缘达1 cm(P=0.036)和复发后再次手术(P=0.041)是生存的保护性因素,而术后复发(P=0.023)是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施,可以明显改善患者的术后生存。
Objective To evaluate the efficacy of surgical treatment of liver metastasis of colorectal cancer. Methods The data of 470 patients with liver metastases from colorectal cancer admitted to Zhongshan Hospital of Fudan University from January 1, 2000 to December 31, 2005 were analyzed to evaluate the effect of surgical treatment on their survival. Results Of the 196 patients with concurrent liver metastases, 30 (15.3%) had surgery and 103 (37.6%) had surgery in 274 patients with synchronous liver metastasis. The mortality rate of concurrent liver transplantation group (3.3%) was higher than that of heterotopic liver transplantation group (1.9%) (P <0.05). At June 31, 2006, the end of follow-up was 100%. The 1, 3, 5-year survival rates and median survival time of patients with simultaneous liver metastasis in operation group were similar to those in patients with heterotopic liver metastasis (P> 0.05) , But the postoperative recurrence rate was higher (36.7% vs 20.4%, P = 0.030). The survival rate at 1, 3, and 5 years was significantly lower in 49 patients with surgical indications than in surgery (P = 0.003). In the simultaneous liver metastasis group, the survival rates at 1, 2 and 3 years were similar to those in 22 cases with stage Ⅰ primary resection of primary hepatic metastases and 8 cases with stage Ⅱ surgery (P> 0.05). Survival risk analysis found survival surges up to 1 cm (P = 0.036) and reoperation (P = 0.041) were protective factors for survival, whereas postoperative recurrence (P = 0.023) was a risk factor for survival. Conclusion Surgical treatment is the first choice for treatment of liver metastasis of colorectal cancer, which can significantly improve the postoperative survival of patients.