|摘要||目的 探讨腹腔镜手术用于治疗可切除的结直肠癌伴肝转移的可行性和安全性,并评价其中短期生存效果.方法 前瞻性收集2009年1月至2014年1月北京大学第三医院36例术前评估为可切除的结直肠癌伴肝转移(CRCLM)并拟接受腹腔镜结直肠癌根治术及腹腔镜肝切除术患者的临床病理资料,其中l例中转开腹,其余35例患者均完成手术.男性24例,女性11例;年龄35 ～ 80岁,平均年龄(64±12)岁,中位年龄67岁.原发肿瘤分别为家族性腺瘤性息肉病并横结肠癌l例,盲肠癌及升结肠癌5例,降结肠癌l例,乙状结肠癌14例,直肠癌14例;其中同时性CRCLM27例,异时性CRCLM 8例.所有患者的诊治在多学科综合治疗模式下完成,采用Kaplain-Meire生存曲线计算累积总生存率及无病生存率.结果 结直肠癌手术包括全结肠切除术1例,右半结肠癌、左半结肠癌、乙状结肠癌、直肠癌根治术分别为5、1、14、14例;肝脏手术包括肝脏解剖性切除术10例,单纯肝转移灶局部切除行术21例,单纯肝脏解剖性切除联合转移灶局部切除术4例;共切除35个结直肠癌病灶及62个肝转移病灶.结直肠和肝脏手术的平均术中出血量为(80±32)和(212±153)ml,中位术中出血量分别为70 ml和150 ml.1例腹腔镜右半肝切除联合腹腔镜全结肠切除患者术后发生胆漏,其余患者均未发生吻合口漏、肝功能不全、胆漏、腹腔感染、腹腔出血等并发症.术后平均随访时间(26±16)个月,中位随访时间22个月,15例复发或转移,4例死于晚期肿瘤,1年、3年总生存率分别为92.9％、79.4％,1年、3年无瘤生存率分别为61.1％、49.4％.结论 腹腔镜手术用于审慎选择的可切除结直肠癌肝转移是安全、可行的,并使同期结直肠切除联合肝切除成为可能,短-中期生存效果可以接受,长期生存效果值得期待.
Objective To explore the feasibility and safety of laparoscopic radical coloproctectomy and hepatectomy for resectalble colorectal cancer with liver metastases (CRCLM),and evaluate the survival outcomes of short-middle term for these patients.Methods Totally 36 cases of CRCLM which were evaluated to undergo laparoscopic coloproctectomy and hepatectomy preoperatively,were enrolled from January 2009 to January 2014,including 28 synchronous and 8 metachronous CLM respectively.Laparoscopic colorectal resection and hepatectomies were performed in 35 cases,including 24 male and 11 female patients,with a mean age of (64 ± 12) years and a median age of 67 years (ranging from 35 to 80 years).Management strategies were made by a board of multi-disciplinary team.Intra-operative ultrasonography was used to detect the metastases in all cases.Overall survival and disease free survival were calculated by Kaplan-Meier curve.Results Radical total colectomy,right hemicolectomy,left hemicolectomy,sigmoidectomy,and proctectomy and were performed in 1 case of familial adenomatous polyposis with transverse colon cancer,5 cases of cecal or asending colon cancer,1 case of descending colon cancer,14 cases of sigmoid colon cancer,and 14 cases of rectal cancer respectively.Metastasectomy only,anatomic hepatectomy only,and metastasectomy plus anatomic hepatectomy were done in 21,10 and 4 cases respectively.Totally 35 colorectal tumors and 62 liver lesions were removed.The mean blood loss of colorectal and liver surgery were (80 ± 32) and (212 ± 153) ml,the median blood loss was 70 ml and 150 ml respectively.Colorectal and hepatic specific complications were not observed in all cases except a case of biliary leakage following right hemihepatectomy.Relapses were observed in 15 cases during a mean follow-up of (26 ± 16) months (median follow-up of 22 months).Four cases died of late-stage cachexia.The 1-and 3-year cumulative overall survival rates were 92.9％ and 79.4％ respectively.The 1-and 3-year cumulative disease free survival rates were 61.1％ and 49.4％ respectively.Conclusions Laparoscopic coloproctectomy and hepatectomy for resectable CRCLM in carefully selected cases is safe and feasible,which makes simultaneous surgery possible.The oncologic outcome of short-middle term is acceptable,and long-term survival is expected.|
姚宏伟,修典荣,付卫,等. 腹腔镜手术治疗可切除的结直肠癌伴肝转移的前瞻性病例系列研究[J]. 中华外科杂志,2014,52(12):919-923.