新辅助化疗对结直肠癌肝转移患者肝功能及组织学的影响

摘要

目的 探讨新辅助化疗对结直肠癌肝转移患者肝功能及组织学的影响.方法 回顾性分析2010年1月至2012年9月佛山市第一人民医院收治的65例结直肠癌肝转移行肝切除术患者的临床资料.其中39例患者接受连续6个周期的FOLFOX7方案(5-氟尿嘧啶+亚叶酸钙+奥沙利铂)化疗,停药1个月后行肝部分切除术(研究组)；26例患者未经化疗直接行肝部分切除术(对照组).比较两组患者的围手术期情况、术前和术后肝功能、术后并发症以及肝组织病理学改变.组间比较采用t检验或x2检验,重复测量的数据采用重复测量的方差分析.结果 研究组和对照组患者手术时间分别为(195±37) min和(190±41) min,两组比较,差异无统计学意义(t=0.1,P＞0.05).研究组患者术中出血量为(410±75)ml,显著多于对照组患者的(348±44)ml(t =6.3,P＜0.05).研究组患者术后3d血清AST及ALT值分别为(328±121)U/L和(330±120) U/L,显著高于对照组患者的(160 ±22) U/L和(168±26) U/L(t=13.4,12.8,P＜0.05).研究组和对照组患者术前PT、AST、ALT、TBil和Alb比较,差异无统计学意义(t=1.0,0.0,1.4,1.3,0.4,P＞0.05).研究组患者术后7d血清AST及ALT值分别为(243±132) U/L和(253±147) U/L,显著高于对照组患者的(90±17) U/L和(99±16) U/L(t=12.5,12.0,P ＜0.05).研究组患者大体标本外观淤血、水肿者占71.8％ (28/39),对照组患者无外观淤血、水肿者,两组比较,差异有统计学意义(x2=90.0,P＜0.05).研究组患者肝窦状隙扩张伴肝细胞萎缩、坏死发生率达48.7％(19/39),对照组患者为15.4％(4/26),两组比较,差异有统计学意义(x2=89.2,P＜0.05).结论 FOLFOX7方案长期化疗在停药1个月后对肝功能无明显影响,但对行肝部分切除术后肝功能有影响,且改变了肝实质,有可能对手术产生不良影响.%Objective To investigate the effects of neoadjuvant chemotherapy on the hepatic function and histology of liver in patients with hepatic metastasis of colorectal cancer.Methods The clinical data of 65 patients with hepatic metastasis of colorectal cancer who received hepatectomy at the First People's Hospital of Foshan from January 2010 to September 2012 were retrospectively analyzed.Thirty-nine patients were in the experimental group,and they received partial hepatectomy 1 month after receiving a 6-month continous FOLFOX7 chemotherapy (5-fluorouracil + calcium leucovorin + oxaloplatin) ; 39 patients were in the control group,and they received partial hepatectomy without adjuvant chemotherapy.The perioperative condition,pre-and postoperative hepatic function,postoperative complications and the histopathological changes of the hepatic tissues of the 2 groups were compared by t test or chi-square test,data repeated measured were analyzed using the repeated measure analysis of variance.Results The operation time of the experimental group and the control group were (195 ± 37)minutes and (190 ±41) minutes,respectively,with no significant difference (t =0.1,P＞0.05).The operative blood loss of the experimental group was (410 ± 75)ml,which was significantly greater than (348 ± 44) ml of the control group (t =6.3,P ＜ 0.05).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 3 were (328 ± 121)U/L and (330 ± 120)U/L in the experimental group,which were significantly higher than (160 ±22) U/L and (168 ±26) U/L of the control group (t =13.4,12.8,P ＜ 0.05).There were no significant differences in the levels of prothrombin time,AST,ALT,total bilirubin and albumin between the experimental group and the control group (t =1.0,0.0,1.4,1.3,0.4,P ＞ 0.05).The levels of AST and ALT at postoperative day 7 were (243 ± 132) U/L and (253 ± 147)U/L in the experimental group,which were significantly higher than (90 ± 17)U/L and (99 ± 16)U/L of the control group (t=12.5,12.0,P＜0.05).The incidence of congestion and edema of the liver was 71.8％ (28/39) in the experimental group,which was significantly higher than 0 (0/26) of the control group (x2 =90.0,P ＜ 0.05).The incidence of hepatic sinusoid expansion with liver cellular altrophy and necrosis was 48.7％ (19/39),which was significantly higher than 15.4％ (4/26) of the control group (x2=89.2,P ＜ 0.05).Conclusion There is no effect of long-time FOLFOX7 chemotherapy on the hepatic function of the patients with hepatic metastasis of colorectal cancer who received hepatectomy 1 month later,but the postoperative hepatic function is affected.The hepatic parenchyma is changed after adjuvant chemotherapy,which might have adverse effect on hepatectomy.