结直肠癌肝转移的手术治疗及预后分析(1)
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【摘要】目的探讨结直肠癌肝转移患者手术治疗的指征、相关病理因素及手术治疗对预后的影响。方法回顾性分析本院2000年1月至2007年12月间经手术治疗的75例结直肠癌肝转移患者的临床资料。结果本组同时性肝转移62例,异时性肝转移13例,均在结直肠癌原发灶根治性切除基础上,行肝叶规则或不规则切除70例,结节切除活检5例。术后出现并发症10例。术后1年,3年,5年累积生存率分别为74.67%,58.67%,28.00%。生存分析显示:肝切除术后的生存率与原发灶的分化程度、术前CEA、Duke’s分期、肝转移数目、组织分型及淋巴结受侵有关。结论临床病理分期早,肿瘤分化程度高,转移灶数目≤2,术前CEA水平低的患者预后好;手术治疗是结直肠癌肝转移的首选治疗方法。
【关键词】
结直肠癌;肝转移;手术;预后
Prognostic analysis of surgical resection for patients with liver metastases from colorectal carcinoma
LAI Xinfeng,LIN Lianghui,ZHANG Maozhong.Department of Surgery,Yangjiang People Hospital,Guangdong Province 529500,China
【Abstract】ObjectiveTo assess the indication and efficacy of surgical treatment for patients with hepatic metastases from colorectal carcinoma.MethodsClinical data of 75 patients with hepatic metastases from colorectal carcinoma undergoing surgery from January 2000 to December 2007 were analyzed retrospectively.ResultsAmong 75 patients,62 patients were found to have synchronous hepatic metastasis and 13 patients were found to have metachronous hepatic metastases.70 patients underwent resection of hepatic metastases and complications occurred in 10 patients.The 1,3 and 5year survival rates were 74.67%,58.67% and 28.00% respatectomy.Univariate analysis revealed that solitary metastasis was a significant factor for favorable prognosis after surgery .The expression ofpreoperative CEA,Dukes stage,the number of hepatic metastases,status of lymph node metastasis and histological differentiation of the primary colorectal carcinoma were all significant factors for prognosis after surgery.ConclusionThe hepatic metastases from colorectal cancer should be treated by a surgical approach.T earlier stage of clinical pathology,higher differentiation extent,metastases less than 2,and lowlevel expression of preoperative CEA predict a better survival.
【Key words】
Colorectal carcinoma;Liver metastasis;Surgical treatment;Prognosis
结直肠癌肝转移在临床上十分常见,文献报道[1]约40%~50%结直肠癌发生同时或异时性肝转移。非手术治疗效果差,采用手术彻底切除结直肠癌原发灶和肝转移灶是获得长期生存的有效治疗方法。本研究回顾性分析2000年1月至2007年12月在本院手术治疗结直肠癌肝转移患者75例临床资料,探讨结直肠癌肝转移的手术适应证、相关病理因素及手术治疗对预后的影响,为提高结直肠癌治疗效果提供临床依据。
1资料与方法 ......
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