刘铭, 王崑, 包全, 王宏伟, 金克敏, 闫晓峦, 邢宝才. 保留肝实质的治疗方式在结直肠癌肝转移手术切除中的应用分析[J]. 中国肿瘤临床, 2017, 44(23): 1179-1183. DOI: 10.3969/j.issn.1000-8179.2017.23.922
引用本文: 刘铭, 王崑, 包全, 王宏伟, 金克敏, 闫晓峦, 邢宝才. 保留肝实质的治疗方式在结直肠癌肝转移手术切除中的应用分析[J]. 中国肿瘤临床, 2017, 44(23): 1179-1183. DOI: 10.3969/j.issn.1000-8179.2017.23.922
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LIU Ming, WANG Kun, BAO Quan, WANG Hongwei, JIN Kemin, YAN Xiaoluan, XING Baocai. Analysis of parenchymal-sparing hepatectomy in surgical treatment of colorectal liver metastases[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2017, 44(23): 1179-1183. DOI: 10.3969/j.issn.1000-8179.2017.23.922
Citation: LIU Ming, WANG Kun, BAO Quan, WANG Hongwei, JIN Kemin, YAN Xiaoluan, XING Baocai. Analysis of parenchymal-sparing hepatectomy in surgical treatment of colorectal liver metastases[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2017, 44(23): 1179-1183. DOI: 10.3969/j.issn.1000-8179.2017.23.922
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保留肝实质的治疗方式在结直肠癌肝转移手术切除中的应用分析

Analysis of parenchymal-sparing hepatectomy in surgical treatment of colorectal liver metastases

    摘要
  • 摘要:
      目的   探讨保留肝实质的治疗方式在结直肠癌肝转移（colorectal liver metastases, CRLM）手术切除中的意义。
      方法   回顾性分析北京大学肿瘤医院2000年1月至2016年5月手术切除的CRLM患者377例, 根据手术方式分为保留肝实质（parenchymalsparing hepatectomy, PSH）组305例和大范围肝切除（major hepatectomy, MH）组72例。比较两组患者的临床特征、手术情况、术后并发症及预后。
      结果  PSH组肝转移灶个数少于MH组, 差异比较具有统计学意义（P=0.000）。全组采用PSH治疗的患者占80.9%, 且随时间增长逐渐增多。PSH组手术时间比MH组短（177.5 minvs.220 min, P=0.000）, 手术出血比MH组少（150 mLvs. 300 mL, P=0.000）, 术后并发症发生率比MH组低（47.4%vs.64.8%, P=0.008）。PSH组与MH组患者的总生存（overall survival, OS）时间、肝内无复发生存（hepatic recurrence free survival, HFRS）时间差异无统计学意义。PSH组患者复发后接受局部治疗的比例明显增加（42.8%vs.25.6%, P=0.040）, 复发患者中接受局部治疗的患者生存期明显延长（58个月vs.24个月, P=0.000）。
      结论  CRLM患者手术时采用PSH的治疗方式肝内复发率更低, 安全性更高, 复发后再次接受局部治疗的可能性明显增加, 是推荐的治疗模式。

     

    Abstract:
      Objective  To analyze the role of parenchymal-sparing hepatectomy(PSH) in surgical treatment of colorectal liver metastases(CRLM).
      Methods  All CRLM patients registered in our database who underwent liver resection were assigned into two groups:the PSH group and the major hepatectomy(MH) group.Clinical characteristics were retrospectively analyzed.Surgical outcomes, survival time, and recurrence were compared between the two groups.
      Results  A total of 377 patients were enrolled.Except for tumor numbers, no significant difference was found in patient demographics and tumor characteristics between the 2 groups.The rate of PSH increased over the study period.Short-term surgical outcomes were better in the PSH group than in the MH group.Surgery time was significantly shorter(177.5 minvs.220 min, P=0.000), blood loss was significantly reduced(150 mLvs.300 mL, P=0.000), and morbidity was significantly reduced(47.4%vs.64.8%, P=0.008).No significant difference was found in overall survival(OS) time(43 mvs.41 m, P=0.750) between the 2 groups.Hepatic recurrence-free survival time(21 mvs.13 m, P=0.344) was similar between the 2 groups. However, local treatment was more frequently performed in the PSH group(42.8%vs.25.6%, P=0.040) when disease recurred.The 5-year OS was significantly better in patients undergoing local treatment than in those without undergoing local treatment(58 mvs.24 m, P=0.000), for hepatic recurrence.
      Conclusion  PSH did not increase hepatic recurrence but improve salvage ability in case of recurrence with a better short-term surgical outcome.PSH should be the recommended approach at initial hepatectomy.

     

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