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目的 探讨结直肠癌肝转移一期联合手术辅助化疗的有效途径及临床价值。方法回顾性分析一期联合手术切除原发癌及转移癌 ,经肝动脉门静脉双置泵栓塞灌注化疗 ,肿瘤局部注射无水酒精及热电疗法综合性治疗结直肠癌肝转移 36例的临床资料。结果 本组 36例结直肠癌患者原发癌均获切除 ,其中一期切除肝转移癌 17例 ,6例复发 ,4例再次手术切除。 19例不能切除的转移性肝癌 ,行肝动脉门静脉双置泵栓塞灌注化疗 ,无水酒精注射和热电疗法。肿瘤直径平均缩小5 7%,其中 4例因肿瘤缩小行二期手术切除。 1、2、3年生存率分别为 :切除组 94%,82 %,6 5 %;明显高于置泵组的 74%,5 3%,32 %(P <0 0 1)。结论 结直肠癌肝转移一期联合手术切除加肝动脉门静脉双置泵栓塞灌注化疗 ,是一种首选而有效的治疗方法。不能切除肝转移癌者 ,只要切除原发肿瘤 ,肝动脉门静脉置泵栓塞灌注化疗 ,可明显延长病人生存期 ,改善预后。
Objective To explore the effective route and clinical value of the first stage of colorectal liver metastasis combined with adjuvant chemotherapy. Methods A retrospective analysis of one-stage combined surgical resection of primary and metastatic carcinomas, transcatheter arterial portosystemic vein embolization with perfusion chemotherapy, local injection of absolute ethanol and thermotherapy combined therapy for colorectal cancer liver metastases in 36 patients. Results The primary cancers of 36 patients with colorectal cancer were all removed in this group. Among them, 17 cases had metastatic liver cancer in one stage, 6 cases had recurrence, and 4 cases were re-excised. Nineteen patients with unresectable metastatic liver cancer underwent dual hepatic arterial portal vein embolization with perfusion chemotherapy, absolute alcohol injection and thermotherapy. The average diameter of the tumors was reduced by 57%. Four of them had undergone two-stage surgical resection due to tumor shrinkage. The 1-, 2-, and 3-year survival rates were 94%, 82%, and 65 % in the resection group, which were significantly higher than those in the pump group (74%, 53%, 32%, P <0 01). Conclusion One-stage resection of colorectal liver metastasis combined with hepatic arterial portal vein double embolization infusion chemotherapy is a preferred and effective treatment. In patients with unresectable hepatic metastases, as long as primary tumors are removed, hepatic arterial portal vein embolization and embolization chemotherapy can significantly prolong patient survival and improve prognosis.