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目的评价结直肠癌多处肝转移后分次行肝切除手术的可行性和临床结果。方法 2002年5月至2011年11月,共有214例结直肠癌肝转移患者行253次肝切除手术。回顾性分析其中21例计划行分次肝切除手术患者的性别、年龄、癌胚抗原(CEA)水平、甲胎蛋白(AFP)水平、化疗病史、肿瘤原发部位、分期、肝转移病灶数量、大小、分布、手术切除类型、手术时间、术中失血量、术后并发症及生存情况。结果 21例患者计划行分次肝切除手术,16例(76.2%)患者完成了第二次肝切除手术。5例没有完成第二次肝切除手术患者中3例患者因为疾病进展而放弃第二次手术,1例患者临床状况较差,1例患者首次手术后死亡。完成分次手术患者比没有进行第二次手术的患者病灶明显更少[(4.6±3.4)个vs.(7.5±2.9)个,P<0.05]。两组患者病灶大小、发现结直肠癌时同时发现肝转移情况或者CEA水平没有明显不同。第一次和第二次肝切除术后并发症发生率没有明显不同(38.1%vs.31.3%)。平均存活时间是19个月。完成分次手术患者3年生存率为62.5%。结论结直肠癌肝转移分次肝切除手术致残率和致死率可以接受,对于一次手术无法完成根治切除的患者提供了一个很好的选择。
Objective To evaluate the feasibility and clinical results of subtotal hepatectomy after multiple liver metastases of colorectal cancer. Methods From May 2002 to November 2011, a total of 214 patients with liver metastases from colorectal cancer underwent 253 liver resections. We retrospectively analyzed the gender, age, carcinoembryonic antigen (CEA) level, AFP level, chemotherapy history, primary tumor location, stage and number of liver metastases in 21 patients scheduled for subtotal hepatectomy. Size, distribution, type of surgical resection, operation time, intraoperative blood loss, postoperative complications and survival. Results Twenty-one patients underwent scheduled hepatectomy and 16 patients (76.2%) underwent a second hepatectomy. Three of the five patients who did not undergo a second hepatectomy underwent surgery for the second because of disease progression. One patient had a poor clinical status and one patient died after the first operation. Patients who underwent fractional surgery had significantly fewer lesions than those who did not undergo second surgery [(4.6 ± 3.4) vs. (7.5 ± 2.9), P <0.05]. Two groups of patients with lesion size, colorectal cancer were found at the same time found that liver metastases or CEA levels did not differ significantly. There was no significant difference in the incidence of complications after the first and second hepatectomy (38.1% vs.31.3%). The average survival time is 19 months. Three-year survival rate of 62.5% patients completed subtotal surgery. Conclusion The morbidity and mortality of hepatectomy for liver metastases from colorectal cancer can be accepted. It is a good choice for patients who can not complete radical resection in one operation.