大肠癌肝转移腹腔镜辅助同期切除两例及相关文献分析
发布时间：2018-08-03 12:13
【摘要】：背景:大肠癌是胃肠道常见的恶性肿瘤,目前全世界的发病率处于上升状态。若不加以治疗,患者的5年生存率仅有0-5%。研究表明,大约1/3的患者在首次诊断为大肠癌时,已有同期转移。其中50%的患者表现为肝转移,这也是大肠癌治疗效果欠佳的主要原因。目前手术切除原发灶及肝转移灶是大肠癌肝转移的主要治疗方式。射频消融治疗(RFA)、经皮无水酒精注射(PEI)、乙酸注射、微波凝固术以及经导管动脉化疗栓塞(TACE)等替代治疗亦取得了较好的治疗效果。系统化疗作为治疗恶性肿瘤的传统方法,也被广泛用于大肠癌的治疗。方法:病例1患者为48岁男性,因"查体发现肝占位并直肠占位1周"入院,住院期间行腹腔镜下直肠癌根治术+肝左外叶切除+肝右叶肿瘤切除+射频消融术,术中取肋缘下切口切除病灶并腹腔镜辅助断端吻合,术后2年出现肝复发灶,在外院接受20个周期系统化疗、一次手术治疗、多次射频消融术及无水酒精注入术等,存活4年1个月。病例2患者为48岁男性,因"腹泻半年,粘液血便2个月"入院,住院期间行腹腔镜下直肠癌前切除术+左半肝切除术,术后随访8年2个月,期间患者未出现复发和转移灶,且能够正常生活和工作。两位患者均在同期诊断为大肠癌肝转移,并先后接受了大肠癌肝转移的腹腔镜同期切除。不同的是,病例1患者在术后接受了多次化疗、RFA、PEI等治疗,术后仅生存了 4年余;病例2患者在术后未接受任何其他治疗,术后随访达8年余。通过收集两例大肠癌肝转移患者的临床资料,对其检查结果和治疗进行比较,结合相关研究和文献进行分析,结果提示大肠癌肝转移原发灶及肝转移灶如果能同时手术切除应当同期手术切除,腹腔镜手术或腔镜辅助能够减轻手术创伤。我们一例病人的临床资料提示大肠癌肝转移手术完整切除后不做进一步辅助治疗亦可能取得长期生存。结论:根据对相关文献及研究进展汇总,结合两例个案的临床资料支持,我们认为大肠癌肝转移的患者如能同时将原发灶和肝转移灶切除应首选一期手术切除,且腹腔镜辅助同期一个切口切除原发灶和肝转移灶是可行的;针对选择性大肠癌肝转移患者,术后无相关辅助治疗亦可能获得长期生存效果。
[Abstract]:Background: colorectal cancer is a common malignant tumor in the gastrointestinal tract. If left untreated, the 5-year survival rate was only 0-5%. Studies have shown that about a third of patients had metastases at the same time when they were first diagnosed with colorectal cancer. Liver metastases were found in 50% of the patients, which was the main reason for the poor treatment of colorectal cancer. At present, surgical resection of primary tumor and liver metastasis is the main treatment of liver metastasis of colorectal cancer. Radiofrequency catheter ablation (RFCA) for the treatment of (RFA), with percutaneous anhydrous alcohol injection of (PEI), acetic acid, microwave coagulation and transcatheter arterial chemoembolization (TACE) has also achieved good results. Systemic chemotherapy, as a traditional method for the treatment of malignant tumors, is also widely used in the treatment of colorectal cancer. Methods: case 1, a 48-year-old male, was admitted to hospital for "1 week of liver mass and rectal space occupation". Laparoscopic radical resection of rectal cancer was performed with radiofrequency ablation in the left lateral lobe of the liver, resection of the right lobe of the liver, and resection of the tumor in the right lobe of the liver. Intraoperative subcostal incision was used to remove the lesion and laparoscope assisted end-to-end anastomosis. Liver recurrence occurred 2 years after operation. 20 cycles of systemic chemotherapy, one operation, multiple radiofrequency ablation and anhydrous alcohol injection were performed in the external hospital. Survival 4 years and 1 month. Case 2 was a 48-year-old male who was admitted to hospital because of "diarrhea for half a year, mucous stool for 2 months". Laparoscopic anterior resection of the rectal cancer was performed during hospitalization. The patients were followed up for 8 years and 2 months, during which no recurrence or metastasis was found. And be able to live and work normally. Both patients were diagnosed with liver metastasis of colorectal cancer at the same time and underwent laparoscopic simultaneous resection of liver metastasis of colorectal cancer. The difference was that case 1 received multiple chemotherapy and RFAP PEI and survived for more than 4 years. Case 2 received no other treatment after operation and was followed up for more than 8 years. The clinical data of two patients with liver metastasis of colorectal cancer were collected, the results of examination and treatment were compared, and the related research and literature were analyzed. The results suggest that if the primary liver metastases and liver metastases of colorectal cancer can be resected simultaneously, the surgical trauma can be alleviated by laparoscopy or laparoscopy. The clinical data of one patient suggest that long-term survival may be achieved without further adjuvant therapy after complete resection of liver metastases from colorectal cancer. Conclusion: according to the summary of relevant literature and research progress, combined with the clinical data of two cases, we believe that the primary tumor and liver metastases should be removed first if the patients with liver cancer metastasis can be removed at the same time. Laparoscopically assisted simultaneous resection of primary focus and hepatic metastases is feasible, and no associated adjuvant therapy may be effective for long term survival in patients with selective liver metastasis of colorectal cancer.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
本文编号：2161714
[Abstract]:Background: colorectal cancer is a common malignant tumor in the gastrointestinal tract. If left untreated, the 5-year survival rate was only 0-5%. Studies have shown that about a third of patients had metastases at the same time when they were first diagnosed with colorectal cancer. Liver metastases were found in 50% of the patients, which was the main reason for the poor treatment of colorectal cancer. At present, surgical resection of primary tumor and liver metastasis is the main treatment of liver metastasis of colorectal cancer. Radiofrequency catheter ablation (RFCA) for the treatment of (RFA), with percutaneous anhydrous alcohol injection of (PEI), acetic acid, microwave coagulation and transcatheter arterial chemoembolization (TACE) has also achieved good results. Systemic chemotherapy, as a traditional method for the treatment of malignant tumors, is also widely used in the treatment of colorectal cancer. Methods: case 1, a 48-year-old male, was admitted to hospital for "1 week of liver mass and rectal space occupation". Laparoscopic radical resection of rectal cancer was performed with radiofrequency ablation in the left lateral lobe of the liver, resection of the right lobe of the liver, and resection of the tumor in the right lobe of the liver. Intraoperative subcostal incision was used to remove the lesion and laparoscope assisted end-to-end anastomosis. Liver recurrence occurred 2 years after operation. 20 cycles of systemic chemotherapy, one operation, multiple radiofrequency ablation and anhydrous alcohol injection were performed in the external hospital. Survival 4 years and 1 month. Case 2 was a 48-year-old male who was admitted to hospital because of "diarrhea for half a year, mucous stool for 2 months". Laparoscopic anterior resection of the rectal cancer was performed during hospitalization. The patients were followed up for 8 years and 2 months, during which no recurrence or metastasis was found. And be able to live and work normally. Both patients were diagnosed with liver metastasis of colorectal cancer at the same time and underwent laparoscopic simultaneous resection of liver metastasis of colorectal cancer. The difference was that case 1 received multiple chemotherapy and RFAP PEI and survived for more than 4 years. Case 2 received no other treatment after operation and was followed up for more than 8 years. The clinical data of two patients with liver metastasis of colorectal cancer were collected, the results of examination and treatment were compared, and the related research and literature were analyzed. The results suggest that if the primary liver metastases and liver metastases of colorectal cancer can be resected simultaneously, the surgical trauma can be alleviated by laparoscopy or laparoscopy. The clinical data of one patient suggest that long-term survival may be achieved without further adjuvant therapy after complete resection of liver metastases from colorectal cancer. Conclusion: according to the summary of relevant literature and research progress, combined with the clinical data of two cases, we believe that the primary tumor and liver metastases should be removed first if the patients with liver cancer metastasis can be removed at the same time. Laparoscopically assisted simultaneous resection of primary focus and hepatic metastases is feasible, and no associated adjuvant therapy may be effective for long term survival in patients with selective liver metastasis of colorectal cancer.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
【参考文献】
相关期刊论文 前3条
1 Yuan Li;Xinyu Bi;Jianjun Zhao;Zhen Huang;Jianguo Zhou;Zhiyu Li;Yefan Zhang;Hong Zhao;Jianqiang Cai;;Simultaneous hepatic resection benefits patients with synchronous colorectal cancer liver metastases[J];Chinese Journal of Cancer Research;2016年05期
2 江陈;常家聪;;大肠癌的治疗方法研究进展[J];安徽医药;2012年02期
3 施东华;王小林;;大肠癌肝转移机制及诊治进展[J];中国医学计算机成像杂志;2010年01期
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