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学科主题: 外科学
题名:
可切除结直肠癌伴肝转移的微创手术治疗模式探索:前瞻性研究
其他题名: Minimally invasive surgery for resectable colorectal cancer with liver metastases: a prospective study
作者: 姚宏伟; 修典荣; 付卫; 袁炯; 王德臣; 蒋斌; 马朝来; 原春辉; 孙涛; 马力文; 曹宝山; 刘剑羽; 陈明; 陈文; 谭石; 黄永辉; 张莉; 石雪迎
关键词: 结直肠癌伴肝转移 ; 可切除性 ; 微创手术 ; Colorectal cancer with liver metastases ; Resectability ; Minimally invasive surgery
刊名: 中华肝胆外科杂志
发表日期: 2012
DOI: 10.3760/cma.j.issn.1007-8118.2012.11.010
卷: 18, 期:11, 页:841-845
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 探索可切除结直肠癌伴肝转移(colorectal cancer with liver metastasis,CRCLM)的微创手术治疗模式,前瞻性研究微创手术切除CRCLM的安全性及生存效果.方法 2009年1月至2011年8月,共有31例可切除的CRCLM患者入组.所有患者均经基线检查确诊直肠癌伴肝转移且具备可切除性.研究排除了有肝外不可切除转移灶的患者.均经多学科专家协作组联合会诊,制定诊治方案(包括是否行新辅助化疗及其方案、同期或分期手术、是否行微创手术及术式等).结果 31例均完成结直肠及肝脏切除术,并至少接受一种微创术式.31例中接受腹腔镜结直肠切除及腹腔镜肝脏切除者10例,仅接受腹腔镜结直肠切除术者18例,仅接受腹腔镜肝脏切除术3例.26例同时性CRCLM患者中有19例接受同期结直肠切除加肝切除,其余患者均为分期手术.术后无结直肠吻合口漏、肝功能衰竭、胆漏、腹腔感染、腹腔出血等并发症发生.31例中有12例接受新辅助化疗,所有患者术后均接受辅助化疗.术后平均随访23.3个月.随访期间复发及转移13例,其中5例死于肿瘤晚期,总生存率87.1%,无瘤生存率71.0%.结论 对于可切除的CRCLM,微创手术是安全、可行的.微创手术使部分CRCLM患者接受结直肠和肝脏的同期手术成为可能,但需谨慎掌握适应证.微创手术的短-中期生存效果是可以接受的,远期效果值得期待. Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1% and 71.0%,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/73221
Appears in Collections:北京大学第三临床医学院_普通外科_期刊论文

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作者单位: 1.100191,北京大学第三医院普通外科
2.100191,北京大学第三医院肿瘤治疗中心
3.100191,北京大学第三医院放射科
4.100191,北京大学第三医院超声诊断科
5.100191,北京大学第三医院消化内科
6.100191,北京大学第三医院病理科

Recommended Citation:
姚宏伟,修典荣,付卫,等. 可切除结直肠癌伴肝转移的微创手术治疗模式探索:前瞻性研究[J]. 中华肝胆外科杂志,2012,18(11):841-845.
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