结直肠癌肝转移的诊断和治疗

摘要

Objective To probe the methods of diagnosis and the effect of treatment for liver metastases from colon and rectum cancer. Methods Clinical data of 25 patients with liver metastases from colon and rectum cancer were analyzed. Primary cecum-asending colon cancer occurred in 9 cases, transverse colon cancer in 3, descending colon cancer in 2, sigmoid colon cancer in 8 and rectal cancer in 3 cases. Synchronous liver metastases found in 9 cases. Postponent liver maetastases in 16. Liver metastases in left lobe appeared in 15 patients, in anterior segment of right lobe in 4 patients, on both lobes of the liver in 6 patients. Single lesion was seen in 15 cases, multiple in 10 cases. Among 9 patient synchronous liver metastases, left lateral seg-mentectomy was perfermed in 7 cases and plug intubate through portal vein in 1 case, right anterior segmen-tectomy in 2 cases, only intubate through hepatic artery and portal vein with subcutaneous pump respectively in 1 case. Among 16 patient with postponent liver metastases, left lateral segmentectomy was resected in 4 cases, left lobectomy in 5 cases, right anterior segmentectomy in 2 cases, intubate through hepatic artery and portal vein with subcutaneous pump respectively in 2 cases and intubate through femoral artery to hepatic artery in-tervene chemotherapy in 3 cases. Results All cases were followed up for 3 years. There were 5 patients alive among 8 cases in synchronous partial hepactomy (62.5%), 4 patients alive among 11 cases postponent partial hepactomy (36.3%). Conclusion Regardless of synchronous or postponent live metastases, so long as general condition and local condition permit, the operative resection is first choice to increase survival rate. About unresectable patients, intubate through hepatic artery and portal vein with subcutaneous pump respec-tively or intubate through femoral artery to hepatic artery intervene chemotherapy can prolong life.%目的 探讨结直肠癌肝转移的诊断和治疗效果.方法 回顾性分析25 例结直肠癌肝转移的临床资料,其中原发盲升结肠癌9 例,横结肠癌3 例,降结肠癌2 例,乙状结肠癌8 例,直肠癌3 例.同时性肝转移癌9例,异时性肝转移癌16 例.肝左叶转移15 例,肝右叶转移4 例,左右叶转移6 例.单个转移15 例,多个转移10例.高分化腺癌13 例,中分化腺癌5 例,低分化腺癌6 例,未分化腺癌1 例.9 例同时性肝转移癌中施行肝左外叶切除7 例,其中加1 例门静脉插管埋泵化疗;右前叶切除2 例,1 例仅作门静脉和肝动脉双插管埋泵化疗.16例异时性肝转移癌中施行肝左外叶切除4 例,左半肝切除5 例,肝右前叶切除2 例,门静脉和肝动脉双插管埋泵化疗2 例,股动脉插管肝动脉介入治疗3 例.结果 全组均经3 年随访,同时性肝切除术8 例中5 例存活(62.5%),异时性肝切除术11 例中4 例存活(36.3%),仅作门静脉和肝动脉插管埋泵化疗或股动脉插管肝动脉介入化疗6 例中2 年内死亡5 例,3 年死亡1 例,3 年存活率仅16.6%.结论 同时性或异时性结直肠癌肝转移,只要全身情况和局部条件许可,均应首选手术切除治疗,以提高患者生存率.对不能切除的患者,可采用动、静脉插管埋泵或作股动脉插管肝动脉介入化疗,以延长患者生命.