CAJ | 학술논문

目的探讨精准肝切除在结直肠癌肝转移治疗中的应用价值.方法回顾性分析2006年10月至2009年10月天津医科大学附属肿瘤医院收治的85例结直肠癌肝转移患者的临床资料.根据治疗方法分为常规组43例和精准组42例.常规组:术前常规检测评估肝肾功能,增强CT和B超检查评估肿瘤情况;根据术前检查结果行解剖性肝段切除.精准组:除常规组进行的各项检查外,还采用吲哚菁绿排泄试验评估肝脏储备功能;通过CT对肝动脉、肝静脉和门静脉进行三维重建,并测量肝脏体积及剩余肝脏体积;术中使用低中心静脉压;采用术中超声检查明确切除范围并保护好周围脉管结构,进行精确的解剖性肝段切除.观察比较两组患者术中、术后及预后的情况.计量资料采用t检验,计数资料采用x2检验.结果两组患者均无围手术期死亡.常规组和精准组术中全肝血流阻断时间分别为(35±25)min和(64±39)min,出血量分别为(685±524)ml和(486±360)ml,两组比较,差异有统计学意义(t=4.116,-2.033,P＜0.05);术中输血量分别为(228±398)ml和(160±330)mJ,两组比较,差异无统计学意义(t=-0.861,P＞0.05).常规组和精准组患者术后第1天ALT分别为(672±284)U/L和(344±158)U/L,第7天ALT分别为(332±161)U/L和(125±93)U/L;住院时间分别为(18±10)d和(12±6)d;术后并发症发生率分别为26%(11/43)和7%(3/42),两组比较,差异有统计学意义(t=-6.541,-7.232,-3.915,x2=5.251,P＜0.05).常规组和精准组患者术后1年肝脏肿瘤复发率分别为37%(16/43)和21%(9/42);术后1年生存率分别为88%(38/43)和93%(39/42),两组患者预后比较,差异无统计学意义(x2=0.110,0.501,P＞0.05).结论对于结直肠癌肝转移患者,精准肝切除较常规肝切除创伤小,恢复快,更加安全、有效.
목적 탐토정준간절제재결직장암간전이치료중적응용개치.방법 회고성분석2006년10월지2009년10월천진의과대학부속종류의원수치적85례결직장암간전이환자적림상자료.근거치료방법분위상규조43례화정준조42례.상규조:술전상규검측평고간신공능,증강CT화B초검사평고종류정황;근거술전검사결과행해부성간단절제.정준조:제상규조진행적각항검사외,환채용신타정록배설시험평고간장저비공능;통과CT대간동맥、간정맥화문정맥진행삼유중건,병측량간장체적급잉여간장체적;술중사용저중심정맥압;채용술중초성검사명학절제범위병보호호주위맥관결구,진행정학적해부성간단절제.관찰비교량조환자술중、술후급예후적정황.계량자료채용t검험,계수자료채용x2검험.결과 량조환자균무위수술기사망.상규조화정준조술중전간혈류조단시간분별위(35±25)min화(64±39)min,출혈량분별위(685±524)ml화(486±360)ml,량조비교,차이유통계학의의(t=4.116,-2.033,P＜0.05);술중수혈량분별위(228±398)ml화(160±330)mJ,량조비교,차이무통계학의의(t=-0.861,P＞0.05).상규조화정준조환자술후제1천ALT분별위(672±284)U/L화(344±158)U/L,제7천ALT분별위(332±161)U/L화(125±93)U/L;주원시간분별위(18±10)d화(12±6)d;술후병발증발생솔분별위26%(11/43)화7%(3/42),량조비교,차이유통계학의의(t=-6.541,-7.232,-3.915,x2=5.251,P＜0.05).상규조화정준조환자술후1년간장종류복발솔분별위37%(16/43)화21%(9/42);술후1년생존솔분별위88%(38/43)화93%(39/42),량조환자예후비교,차이무통계학의의(x2=0.110,0.501,P＞0.05).결론 대우결직장암간전이환자,정준간절제교상규간절제창상소,회복쾌,경가안전、유효.
Objective To evaluate precise hepatectomy for liver metastases of colorectal cancer. Methods The clinical data of 85 patients with liver metastases of colorectal cancer who were admitted to the Cancer Hospital of Tianjin Medical University from October 2006 to October 2009 were retrospectively analyzed. Forty-two patients received precise hepatectomy(precise group) and 43 received routine hepatectomy (routine group). Evaluation of the hepatic and renal functions and detection of the tumors' condition were done before carrying out anatomical liver resection for patients in the routine group. Hepatic functional reserve of patients in the precise group was detected by indocyanine green excretion test. Hepatic artery, hepatic vein and portal vein were three-dimensionally reconstructed according to the data of computed tomography. The liver volume and residual liver volume of the patients were calculated. Hepatic resection was guided by intra-operative ultrasound in the precise group. Periand postoperative conditions and the results of follow-up of patients in the two groups were compared. All data were analyzed using the t test or chi-square test. Results No perioperative mortality was observed in the two groups.Time of hepatic blood flow occlusion and blood loss were (35±25)minutes and (685 ± 524) ml in the routine group, and (64±39) minutes and (486±360) ml in the precise group, respectively, with a significant difference between the two groups(t=4.116,-2.033, P＜0.05). The volumes of blood transfusion of the routine group and the precise group were (228±398) ml and (160±330)ml, respectively, with no significant difference between the two groups (t=-0.861, P＞0.05). The postoperaive levels of alanine transaminase at day 1 and day 7 were (672±284)U/L and (332±161)U/L in the routine group, and (344±158)U/L and (125 ±93) U/L in the precise group, respectively, with a significant difference between the two groups (t=-6.541,-7.232,P＜0.05). The length of hospital stay and postoperative mobidity were (18±10)days and 26% (11/43) in the routine group, and (12±6)days and 7%(3/42) in the precise group, respectively, with a significant difference between the two groups (t=- 3.915, x2=5.251, P＜0.05). The 1-year tumor recurrence rate and 1-year survival rate were 37% (16/43) and 88% (38/43) in the routine group, and 21% (9/42) and 93% (39/42) in the precise group, with no significant difference between the two groups (x2= 0.110, 0. 501, P＞0.05). Conclusion Precise hepatectomy is superior to routine hepatectomy in aspect of minimal trauma, quick recovery, efficacy and safety.