保留肝实质的治疗方式在结直肠癌肝转移手术切除中的应用分析

发布时间：2018-07-20 18:07

【摘要】：目的:探讨保留肝实质的治疗方式在结直肠癌肝转移(colorectal liver metastases,CRLM)手术切除中的意义。方法:回顾性分析北京大学肿瘤医院2000年1月至2016年5月手术切除的CRLM患者377例,根据手术方式分为保留肝实质(parenchymalsparing hepatectomy,PSH)组305例和大范围肝切除(major hepatectomy,MH)组72例。比较两组患者的临床特征、手术情况、术后并发症及预后。结果:PSH组肝转移灶个数少于MH组,差异比较具有统计学意义(P=0.000)。全组采用PSH治疗的患者占80.9%,且随时间增长逐渐增多。PSH组手术时间比MH组短(177.5 min vs.220 min,P=0.000),手术出血比MH组少(150 m L vs.300 m L,P=0.000),术后并发症发生率比MH组低(47.4%vs.64.8%,P=0.008)。PSH组与MH组患者的总生存(overall survival,OS)时间、肝内无复发生存(hepatic recurrence free survival,HFRS)时间差异无统计学意义。PSH组患者复发后接受局部治疗的比例明显增加(42.8%vs.25.6%,P=0.040),复发患者中接受局部治疗的患者生存期明显延长(58个月vs.24个月,P=0.000)。结论:CRLM患者手术时采用PSH的治疗方式肝内复发率更低,安全性更高,复发后再次接受局部治疗的可能性明显增加,是推荐的治疗模式。
[Abstract]:Objective: to investigate the significance of preserving hepatic parenchyma in resection of (colorectal liver Metastasis Colorectal carcinoma (colorectal liver Metastasis Colorectal Cancer). Methods: from January 2000 to May 2016, 377 patients with CRLM were analyzed retrospectively. They were divided into parenchymalsparing hepatectomy group (305 cases) and major hepatectomy group (72 cases). The clinical features, surgical conditions, postoperative complications and prognosis were compared between the two groups. Results the number of hepatic metastases in PSH group was less than that in MH group, and the difference was statistically significant (P < 0. 000). The total number of patients treated with PSH increased gradually with the increase of time. The operation time in PSH group was shorter than that in MH group (177.5 min vs.220 / min P0. 000), the operative bleeding was less than that in MH group (150ml vs.300 m L P0. 000), and the incidence of postoperative complications was lower than that in MH group (47.4 vs 64.8P0. 008). The postoperative complications in PSH group and MH group were lower than those in MH group (47.4 vs 64.8P0. 008). The incidence of postoperative complications was lower than that in MH group (47.4 vs 64.8P0. 008). Total overall survival time, There was no significant difference in the survival time of (hepatic recurrence free survival without recurrence. The proportion of patients receiving local treatment after recurrence was significantly increased (42.8 vs 25.6P0. 040), and the survival time of patients receiving local treatment in recurrent patients was significantly prolonged (58 months vs.24 / month P0. 000). Conclusion the intrahepatic recurrence rate of PSH is lower and the safety is higher. The possibility of local treatment after recurrence is obviously increased, which is the recommended treatment mode.
【作者单位】：北京大学肿瘤医院暨北京市肿瘤防治研究所肝胆胰外一科恶性肿瘤发病机制及转化研究教育部重点实验室;
【基金】：国家自然科学基金项目(编号:81371868)资助~~
【分类号】：R735.34

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