论文部分内容阅读
目的评估同时性结直肠癌肝转移(SCLM)病人行一期和二期肝切除术的安全性及疗效。方法通过检索Medline数据库,Cochrane图书馆和Google学术搜索,搜集自1999年12月至2012年5月间关于SCLM病人行一期和二期肝切除术的对照研究,对手术资料和预后等进行荟萃分析。结果共纳入14篇文献,2588例SCLM病人,其中一期同步肝切除手术者931例,二期分阶段肝切除手术者1657例。一期手术术后并发症发生率(41.1%)低于二期手术(44.8%),且差异有统计学意义[OR0.79,95%CI,0.65～0.95,P=0.01];同时一期手术术中出血量较少(P=0.02)、住院时间较短(P=0.00);而在围手术期病死率、3年无瘤存活率、5年存活率、手术时间方面一期与二期手术相比差异无统计学意义(P值分别为0.26,0.19,0.86,0.05);其中对于切除3个或以上肝段的大块肝切除,一期与二期手术的手术并发症发生率(P=0.26)、围手术期病死率(P=0.26)差异亦无统计学意义。结论对于可行二期手术的SCLM病人,行一期手术治疗可取得与二期手术相似的治疗效果及并发症发生率;在适当选择的SCLM病人中,同时切除肝转移灶和原发肿瘤的一期手术可被作为首选治疗方案。
Objective To evaluate the safety and efficacy of primary and secondary hepatectomy in patients with simultaneous colorectal cancer liver metastasis (SCLM). METHODS: A meta-analysis of surgical data and prognosis was conducted by searching the Medline database, the Cochrane Library, and Google Scholar to collect control studies of primary and secondary liver resections from December 1999 to May 2012 in patients with SCLM analysis. Results A total of 14 articles were enrolled in this study. Among 2588 patients with SCLM, 931 patients underwent primary liver resection and 1,657 underwent secondary liver resection. The incidence of postoperative complications in stage I surgery was lower than that in stage II surgery (41.1% vs 44.8%, OR 0.79, 95% CI, 0.65-0.95, P = 0.01) There was less bleeding in operation (P = 0.02) and shorter hospital stay (P = 0.00). However, in perioperative mortality, 3-year tumor-free survival, 5-year survival and operation time, (P = 0.26, 0.19, 0.86, 0.05 respectively). Among them, for the resection of large hepatectomy of 3 or more hepatic segments, the incidence of complications in the first and second phases of surgery (P = 0.26). There was no significant difference in perioperative mortality (P = 0.26). Conclusions For SCLM patients who are eligible for second surgery, one-stage surgical treatment can achieve similar therapeutic effect and incidence of complications as second-stage surgery. In a properly selected SCLM patient, resection of one of the liver metastases and the primary tumor Period surgery can be used as the preferred treatment.