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基于限制性肝段切除手术的局部治疗模式改善结直肠癌术后肝脏寡转移的预后分析
Clinical effect of local treatment based on limited segmental resection in improving the prognosis of liver oligometastasis after surgery for colorectal cancer
文章发布日期:2020年07月09日  来源:  作者:李江,候宇,蔡晓蓓,等  点击次数:645次  下载次数:45次

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【摘要】:目的 探讨基于限制性肝段切除手术的局部治疗模式能否较其他非手术模式改善结直肠癌术后肝脏寡转移的预后及其个体化实施方案。方法 收集2012年1月-2018年12月昆明医科大学第一附属医院结直肠癌根治术后肝脏寡转移局部治疗的74例患者的资料,根据治疗模式分为手术组(n=39)和非手术组(n=35)。比较2组患者的治疗方案及并发症。计量资料组间比较采用t检验或Mann-Whitney U检验;计数资料组间比较采用χ2检验或Fisher检验。采用Kaplan-Meier法绘制生存曲线,并计算中位无瘤生存时间(DFS)及总生存时间(OS),log-rank检验进行生存分析。结果 手术组39例患者中开腹23例,腹腔镜16例;术式为单纯限制性肝段/亚段切除11例,联合小病灶楔形切除21例,联合射频消融7例;术后并发症5例,其中出血1例,胆瘘1例,胸腔积液3例。非手术组35例中治疗方式包括超声或CT引导射频消融(RFA)联合经肝动脉化疗栓塞术(TACE) 18例,TACE 5例,RFA 9例,立体定向体部放射治疗3例; TACE术后肝脓肿1例,RFA术后气胸1例。全部病例治疗后30 d后无死亡。手术组与非手术组DFS和OS分别为38(95%CI:31.3~44.9)个月、64(95%CI: 57.6~70.1)个月和27(95%CI: 19.9~34.0)个月、43(95%CI: 36.2~50.0)个月,差异均有统计学意义(χ2值分别为6.072、11.685,P值分别为0.014、0.001)。手术组与非手术组1年及5年生存率分别为92.3%、41.0%与82.8%、14.3%。结论 基于限制性肝段切除手术的局部治疗模式较非手术局部治疗能够显著改善结直肠癌术后肝脏寡转移患者的预后。手术模式依据病灶特点个体化抉择。
【Abstract】:Objective To investigate whether local treatment based on limited segmental resection can improve the prognosis of colorectal liver oligometastases (CRLOM) compared with other non-surgical treatment method, as well as the individualized regimen of this treatment method. Methods A retrospective analysis was performed for the clinical data of 74 CRLOM patients who underwent local treatment in The First Affiliated Hospital of Kunming Medical University from January 2012 to December 2018, and according to the treatment method, they were divided into surgical group with 39 patients and non-surgical group with 35 patients. Treatment regimen and complications were compared between the two groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves and calculate median disease-free survival (DFS) time and overall survival (OS) time, and the log-rank test was used for survival analysis. Results Among the 39 patients in the surgical group, 23 underwent laparotomy and 16 underwent laparoscopy; as for the surgical procedure, 11 underwent limited segmental/subsegmental resection alone, 21 underwent limited segmental/subsegmental resection combined with wedge resection of small lesions, and 7 underwent limited segmental/subsegmental resection combined with radiofrequency ablation (RFA); 5 patients experienced postoperative complications, with bleeding in 1 patient, biliary fistula in 1 patient, and pleural effusion in 3 patients. Among the 35 patients in the non-surgical group, 18 underwent ultrasound- or CT-guided RFA combined with transarterial chemoembolization (TACE), 5 underwent TACE alone, 9 underwent RFA, and 3 underwent stereotactic body radiotherapy; as for postoperative complications, 1 patient experienced liver abscess after TACE, and 1 experienced pneumothorax after RFA. No patient died within 30 days after treatment. The surgical group had a DFS time of 38 months (95% confidence interval [CI]: 31.3-44.9) and an OS time of 27 months (95% CI: 19.9-34.0), and the non-surgical group had a DFS time of 64 months (95% CI: 57.6-70.1) and an OS time of 43 months (95% CI: 36.2-50.0), with significant differences between the two groups (χ2=6.072 and 11.685, P=0.014 and 0.001). The surgical group had a 1-year survival rate of 92.3% and a 5-year survival rate of 41.0%, while the non-surgical group had a 1-year survival rate of 82.8% and a 5-year survival rate of 14.3%. Conclusion Compared with non-local surgical treatment, local treatment based on limited segmental resection can significantly improve the prognosis of CRLOM in patients with colorectal cancer. The surgical procedure should be individualized according to lesion characteristics.
【关键字】:结直肠肿瘤; 肿瘤转移; 肝切除术; 预后
【Key words】:colorectal neoplasms; neoplasm metastasis; hepatectomy; prognosis
【引证本文】:LI J, HOU Y, CAI XB, et al. Clinical effect of local treatment based on limited segmental resection in improving the prognosis of liver oligometastasis after surgery for colorectal cancer[J]. J Clin Hepatol, 2020, 36(8): 1763-1767. (in Chinese)
李江, 候宇, 蔡晓蓓, 等. 基于限制性肝段切除手术的局部治疗模式改善结直肠癌术后肝脏寡转移的预后分析[J]. 临床肝胆病杂志, 2020, 36(8): 1763-1767.

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