同期手术和先肠后肝手术治疗结直肠癌肝转移效果分析

发布时间：2018-03-03 10:55

本文选题：结直肠癌同时性肝转移　切入点：同期手术　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:过去几十年,结直肠癌在我国发病率逐渐升高,大约15%-25%的结直肠癌病人在明确诊断时就合并有肝转移,另有15%-25%的结直肠癌病人在原发灶进行根治手术后发展成肝转移,手术R0切除原发灶和转移灶是可能治愈结直肠癌肝转移的最佳手段。目前对于初始可切除的结直肠癌同时性肝转移病人采取同期手术切除还是分期手术切除仍有争议。本研究分析同期手术切除与先肠后肝手术切除的安全性和近远期效果,从而为临床医生选择最佳手术时机和手术模式来治疗结直肠癌同时性肝转移提供思绪和理论依据。方法:回顾性分析吉林大学中日联谊医院2006年9月-2011年9月收治的71名初始可切除的结直肠癌同时性肝转移患者,其中33名同期手术切除(同期手术组),38名患者先肠后肝手术切除(先肠后肝组)。分析比较两组患者在术中出血量、手术时间、术后并发症的发生率、总住院时间以及生存率之间的差异。结果:两组患者均平稳出院。同期手术组术中平均出血量为476.64±118.33ml,先肠后肝组为559.55±111.78ml,同期手术组平均手术时间229.81±19.33min,先肠后肝组261.92±21.97min,同期手术组平均总住院时间16.97±1.99d,先肠后肝组平均总住院时间19.71±2.64d,两组相比同期手术组优于先肠后肝组,差异具有统计学意义(р0.05)。同期手术组术后并发症发生率为24.2%,先肠后肝组为18.4%,虽同期手术组并发症发生率高于先肠后肝组,但差异不具有统计学意义(р0.05)。同期手术组中位生存时间为35m,先肠后肝组为38m,同期手术组1、3、5年生存率分别为90.9%、48.5%、30.3%,先肠后肝组分别为89.5%、52.6%、28.9%,两组相比差异不具有统计学意义,远期效果相当。结论:同期手术治疗初始可切除的结直肠癌同时性肝转移患者是安全有效的,同期手术与先肠后肝手术相比能降低术中出血量、手术时间、总住院时间,具有社会经济学效益,值得推广。
[Abstract]:Objective: over the past few decades, the incidence of colorectal cancer in our country increased gradually, about 15%-25% of patients with colorectal cancer at the time of diagnosis is associated with liver metastasis, and 15%-25% colorectal cancer patients after radical surgery developed liver metastasis in primary tumor, R0 resection of primary and metastatic is possible the best way to cure with liver metastasis of colorectal cancer. The initial resectable colorectal cancer and liver metastasis treated by simultaneous resection or staging surgery remains controversial. This study analyzed the simultaneous resection and surgical resection of the liver after intestinal safety and short term effect, thus for the treatment of colorectal cancer with synchronous liver transfer offers ideas and theoretical basis for clinicians to select the optimal operation timing and operative mode. Methods: a retrospective analysis of the September 2006 Sino Japanese Friendship Hospital of Jilin University -2011 admitted in September 71 The initial resectable colorectal cancer patients with simultaneous liver metastasis, including 33 surgical resection (operative group), liver resection in 38 patients after the first bowel (liver group after intestinal bleeding). Analysis and comparison of two groups of patients in the operative time, postoperative complication rate, hospitalization the difference between time and survival. Results: two patients were discharged smoothly. The operative group average intraoperative bleeding volume was 476.64 + 118.33ml, the first bowel after liver group was 559.55 + 111.78ml, the operative group average operation time was 229.81 + 19.33min, 261.92 + 21.97min group after first liver intestinal surgery group over the same period, the average total the hospitalization time was 16.97 + 1.99d, the first bowel after liver group the average hospitalization time was 19.71 + 2.64d, two groups of liver surgery group group is better than the first bowel, the difference was statistically significant (P 0.05). The complication rate was 24.2% over the same period after surgery group, the first group was 18.4% after liver intestine, Although the operative group group of liver complications than the first bowel, but the difference was not statistically significant (P 0.05). The operative group the median survival time was 35m, the first bowel after liver group was 38m, the operative group 1,3,5 year survival rates were 90.9%, 48.5%, 30.3%, the first bowel after liver component for 89.5%, 52.6%, 28.9%, the difference between the two groups was not statistically significant, long-term effect. Conclusion: colorectal cancer surgery over the same period the initial resection of synchronous liver metastases is safe and effective, and the first operative intestinal after liver surgery compared to reduce blood volume, the operative time, total hospitalization time has benefits, social economics, and is worthy of promotion.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

【相似文献】