结直肠癌引起的孤立性肝脏转移,手术切除已成为首选疗法。其5年生存率可达22％～39％,但术后有60％会复发,其中30％呈孤立性肝脏转移。随着近10年肝切除手术安全性的提高,死亡率与并发症率已显著降低,对肝脏复发病灶施行反复肝切除的尝试逐渐增加。 病人和方法 1984年至1995年,Paul Broussel医院肝胆外科中心,对243例结直肠癌肝转移患者行肝切除术,病人选择标准为肝复发灶在技术上能手术切除,且不存在无法切除的肝外病变,其中64例行反复肝切除83例次,包括二次肝切除49例,三次肝切除11例,四次肝切除4例。该64例中,原发肿瘤位于结肠45例(70％),直肠19例(30％)。DukeA、B、C级分别占2％、20％、78％。37例(50％)发现时已伴肝转移,结肠切除与首次肝切除平均相隔1～2年。64例中,肝转移为孤立病灶者在首次肝切除时37％,重复肝切除为49％。 Isolated liver metastases due to colorectal cancer have become the preferred therapy. The 5-year survival rate can reach 22% to 39%, but 60% of patients will relapse after surgery, and 30% of them have isolated liver metastases. With the improvement of the safety of liver resection surgery in the past 10 years, the mortality and complication rates have been significantly reduced, and attempts to perform recurrent hepatectomy on liver recurrence lesions have gradually increased. PATIENTS AND METHODS Between 1984 and 1995, the center of hepatobiliary surgery at Paul Broussel Hospital performed hepatectomy on 243 patients with colorectal liver metastases. The patient’s selection criteria was that the liver recurrence was technically surgically removed and there was no unresectable In extrahepatic lesions, 64 cases underwent repeated hepatectomy in 83 cases, including 49 cases of secondary hepatectomy, 11 cases of hepatic resection in 3 cases, and 4 cases of hepatic resection in 4 cases. Of the 64 cases, the primary tumor was located in the colon in 45 cases (70%) and the rectum in 19 cases (30%). Duke A, B, and C levels account for 2%, 20%, and 78%, respectively. 37 cases (50%) had liver metastases when they were found. The average interval between colon resection and first liver resection was 1 to 2 years. In 64 cases, hepatic metastases were isolated lesions at 37% on the first liver resection and 49% on repeated hepatectomy.