CAJ | 학술논문

目的：探讨同期手术切除结直肠癌肝转移的长期疗效及其影响因素。方法回顾性分析2003年7月至2013年7月间于上海复旦大学附属中山医院行同期切除的154例同时性结直肠癌肝转移患者的临床资料。观察患者术后的短期和长期疗效，并对可能影响预后的因素进行多因素Cox回归分析。结果全组无围手术期死亡病例，术后并发症发生率为29．9％（46／154），均经胸腹腔引流和抗感染支持治疗等非手术治疗措施获得治愈或明显缓解。全组5年总生存率为46％，5年无瘤生存率为35％。多因素分析显示，淋巴结阳性（P＝0．000）、转移灶数大于或等于4个（P＝0．017）、转移灶双叶分布（P＝0．004）和切缘阳性（P＝0．001）是总生存率低的独立预后因素；淋巴结阳性（P＝0．031）、转移灶双叶分布（P＝0．001）和合并肝外转移（P＝0．020）是无瘤生存率低的独立预后因素。结论同期切除结直肠癌肝转移安全可行，长期生存也较佳。淋巴结阳性、转移灶数4个以上、转移灶双叶分布、切缘阳性及肝外转移可作为长期预后较差的预测参考。
목적：탐토동기수술절제결직장암간전이적장기료효급기영향인소。방법회고성분석2003년7월지2013년7월간우상해복단대학부속중산의원행동기절제적154례동시성결직장암간전이환자적림상자료。관찰환자술후적단기화장기료효，병대가능영향예후적인소진행다인소Cox회귀분석。결과전조무위수술기사망병례，술후병발증발생솔위29．9％（46／154），균경흉복강인류화항감염지지치료등비수술치료조시획득치유혹명현완해。전조5년총생존솔위46％，5년무류생존솔위35％。다인소분석현시，림파결양성（P＝0．000）、전이조수대우혹등우4개（P＝0．017）、전이조쌍협분포（P＝0．004）화절연양성（P＝0．001）시총생존솔저적독립예후인소；림파결양성（P＝0．031）、전이조쌍협분포（P＝0．001）화합병간외전이（P＝0．020）시무류생존솔저적독립예후인소。결론동기절제결직장암간전이안전가행，장기생존야교가。림파결양성、전이조수4개이상、전이조쌍협분포、절연양성급간외전이가작위장기예후교차적예측삼고。
Objective To analyze long-term outcomes and related risk factors in patients undergoing simultaneous resection of synchronous colorectal liver metastasis. Methods Clinicopathological, short- and long-term outcome data of 154 consecutive synchronous colorectal liver metastasis patients who underwent simultaneous resection between July 2003 and July 2013 were collected and analyzed with Cox multivariate methods retrospectively. Results No perioperative death was found. A total of 46 patients ( 29 . 9%) had complications , which were all successfully treated medically or by percutaneous drainage. The 5-year overall survival rate was 46%, and the 5-year disease-free survival rate was 35%. Four factors were found to be independent predictors of poor overall survival by multivariate analysis:positive lymph node status(P=0.000), number of metastasis focus (≥4)(P=0.017), bilobar liver metastasis distribution (P=0.004) and non-R0 resection of liver metastasis (P=0.001). Three factors were found to be independent predictors of poor disease-free survival by multivariate analysis:positive lymph node status (P=0.031), bilobar liver metastasis distribution (P=0.001) and extrahepatic metastases (P=0.020). Conclusions Simultaneous resection of synchronous colorectal liver metastasis is safe and its short- and long-term outcomes are quite good. Positive lymph node status , number of metastasis focus (≥4), bilobar liver metastasis distribution, non-R0 resection of liver metastasis and extrahepatic metastasis are risk factors of poor long-term prognosis.