CAJ | 학술논문

目的比较射频消融(RFA)与手术切除治疗结直肠癌肝转移的效果,探讨影响预后的相关因素.方法回顾性分析2004年1月至2009年5月第三军医大学西南医院全军肝胆外科研究所收治的120例结直肠癌肝转移患者临床病理资料和随访资料,对患者术后的相关参数进行统计学对比分析.结果 120例肝转移患者RFA治疗62例,手术治疗58例.两组均无围手术期死亡.RFA术后并发症较手术组低,差异有统计学意义(9.7％比24.1％,x2=4.512,P＜0.05).转移癌直径＜4.0 cm者两组复发率及1、3、5年生存率差异无统计学意义(21.4％比10.0％,x2=2.413,P＞0.05;x2=2.248,P＞0.05).转移癌直径≥4.0 cm者复发率及1、3、5年生存率之间差异均有统计学意义(37.5％比26.3％,x2=4.992,P＜0.05;x2=4.370,P＜0.05).至2014年5月108例患者获得为期7～81个月的随访,总体中位生存时间37个月.单因素分析结果显示原发灶分化程度、原发灶N分期、转移癌直径、转移癌类型、肝外转移及癌胚抗原(CEA)水平与结直肠癌肝转移的预后相关(P＜0.05).多因素分析结果显示转移癌类型、转移癌直径、肝外转移及高CEA水平是影响结直肠癌肝转移总生存时间的独立危险因素(OR=2.414,2.560,1.964,1.998;95％CI:1.179 ～2.778,1.420 ～4.615,1.269～3.041,1.295 ～3.084;P＜0.05).结论 RFA适合结直肠癌肝转移的治疗,临床病例选择应严格.转移癌类型、转移癌直径、肝外转移、高CEA水平是影响结直肠癌肝转移总体生存率的独立危险因素.
목적 비교사빈소융(RFA)여수술절제치료결직장암간전이적효과,탐토영향예후적상관인소.방법 회고성분석2004년1월지2009년5월제삼군의대학서남의원전군간담외과연구소수치적120례결직장암간전이환자림상병리자료화수방자료,대환자술후적상관삼수진행통계학대비분석.결과 120례간전이환자RFA치료62례,수술치료58례.량조균무위수술기사망.RFA술후병발증교수술조저,차이유통계학의의(9.7％비24.1％,x2=4.512,P＜0.05).전이암직경＜4.0 cm자량조복발솔급1、3、5년생존솔차이무통계학의의(21.4％비10.0％,x2=2.413,P＞0.05;x2=2.248,P＞0.05).전이암직경≥4.0 cm자복발솔급1、3、5년생존솔지간차이균유통계학의의(37.5％비26.3％,x2=4.992,P＜0.05;x2=4.370,P＜0.05).지2014년5월108례환자획득위기7～81개월적수방,총체중위생존시간37개월.단인소분석결과현시원발조분화정도、원발조N분기、전이암직경、전이암류형、간외전이급암배항원(CEA)수평여결직장암간전이적예후상관(P＜0.05).다인소분석결과현시전이암류형、전이암직경、간외전이급고CEA수평시영향결직장암간전이총생존시간적독립위험인소(OR=2.414,2.560,1.964,1.998;95％CI:1.179 ～2.778,1.420 ～4.615,1.269～3.041,1.295 ～3.084;P＜0.05).결론 RFA괄합결직장암간전이적치료,림상병례선택응엄격.전이암류형、전이암직경、간외전이、고CEA수평시영향결직장암간전이총체생존솔적독립위험인소.
Objective To evaluate the clinical efficacy of radiofrequency ablation(RFA) and surgical treatment of colorectal liver metastases,and to explore the prognostic factors for patients with colorectal liver metastases.Methods The clinicopathological data of 120 patients with colorectal liver metastases who underwent surgical treatment or RFA at the Southwest Hospital from January 2004 to May 2009 were analyzed retrospectively.The postoperative clinical data and follow-up data were statistically analyzed.The follow-up was censored in May 2014.Results Of 120 patients,62 received RFA and 58 received surgical treatment.No patient died perioperatively.There was a significantly lower postoperative complication rate in the RFA group than in the surgical treatment group (9.7％ vs 24.1％,x2 =4.512,P ＜ 0.05).There was no significant difference in recurrence rate and in the 1-,3-,5-year survival rates in patients with metastatic carcinoma of ＜4.0 cm in diameter (21.4％ vs 10.0％,x2 =2.413,P＞0.05;x2 =2.248,P＞0.05),but the difference was significant in patients with metastatic carcinoma of ≥ 4.0 cm in diameter (37.5％ vs 26.3％,x2=4.992,P＜0.05;x2=4.370,P＜0.05).108 patients were followed up for 7 ～ 81 months.The overall median survival was 37 months.Univariate analysis showed differentiation and N staging of the primary tumor,diameter and type of metastases,extrahepatic metastasis,and a high serum carcinoembryonicantigen (CEA) level correlated with prognosis of patients with colorectal liver metastases (P ＜ 0.05).On multivariate analysis,diameter and type of metastases,extrahepatic metastasis,and a high serum CEA were independent predictors of overall survival (OR =2.414,2.560,1.964,1.998;95％ CI:1.179 ～ 2.778,1.420～4.615,1.269～3.041,1.295 ～3.084;P＜0.05).Conclusions RFA can be used in patients with colorectal liver metastases,but these patients should be selected strictly.The type and diameter of metastases,extrahepatic metastasis,and a high serum CEA were independent predictors of overall survival for patients with colorectal liver metastases.