【摘要】 目的探讨同时性结直肠癌肝转移一期行腹腔镜下结直肠癌根治术联合大范围肝切除术的安全性和疗效。方法回顾性分析2016年1月至2019年12月广州中医药大学第二附属医院收治的15例同时性结直肠癌肝转移患者临床资料。其中男9例,女6例;年龄44～75岁,中位年龄53岁。原发病:右半结肠癌5例,左半结肠癌1例,乙状结肠癌5例,直肠癌4例。肝内转移瘤局限于左半肝9例,右半肝5例,肝中叶1例。患者均签署知情同意书,符合医学伦理学规定。患者采用一期同时行腹腔镜下结直肠癌根治联合大范围肝切除术(≥3个肝段),观察手术情况和术后疗效。结果 15例均手术成功,无中转开腹。手术方式包括左半肝切除+乙状结肠切除5例,左半肝切除+Dixon术3例,左半肝切除+左半结肠切除1例,右半肝切除+右半结肠切除4例,右半肝切除+Dixon术1例,肝中叶切除+右半结肠切除1例。手术时间中位数200(150～360) min,术中出血量200(100～350)ml,术中均未输血。术后胆漏1例,胸腔积液2例,无肠漏、出血、肝衰竭、感染、死亡等严重并发症。术后住院时间10(7～15)d。术后采用Folfox6/Xelox+贝伐珠单抗方案辅助化疗。随访时间22(6～42)个月。随访中发现1例残肝转移,1例肺转移,1例死于全身多发转移,其余病例未见复发和转移。结论一期行腹腔镜结直肠癌根治术联合大范围肝切除术治疗同时性结直肠癌肝转移是安全可行的。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of one-stage laparoscopic radical resection of colorectal cancer combined with extensive hepatectomy for synchronal liver metastasis from colorectal cancer.Methods Clinical data of 15 patients with colorectal cancer complicated with synchronal liver metastasis admitted to the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2016 to December 2019 were retrospectively analyzed.Among them,9 patients were male and 6 female,aged from 44 to 75 years with a median of 53 years.Primary diseases were right colon cancer (n=5),left colon cancer (n=1),sigmoid colon cancer (n=5) and rectal cancer (n=4).Intrahepatic metastasis were located in the left lobe (n=9),in the right lobe (n=5),and in the middle lobe (n=1).The informed consents of all patients were obtained and the local ethical committee approval was received.One-stage laparoscopic radical resection of colorectal cancer combined with extensive hepatectomy(≥3 liver segments) was performed.Surgical condition and postoperative efficacy were observed.Results Operations in all 15 patients were completed successfully.No patient was converted to open surgery.The surgical procedures included left hemihepatectomy + sigmoidectomy in 5 cases,left hemihepatectomy + Dixon operation in 3 cases,left hemihepatectomy + left hemicolectomy in 1 case,right hemihepatectomy +right hemicolectomy in 4 cases,right hemihepatectomy + Dixon operation in 1 case,and middle lobe resection + right hemicolectomy in 1 case.The median operation time was 200(150-360) min.Intraoperative blood loss was 200(100-350) ml.No blood transfusion was performed during the operation.Postoperatively,1 patient developed bile leakage and 2 cases of pleural effusion.No severe complications,such as intestinal leakage,bleeding,liver failure,infection and death,were noted.The length of postoperative hospital stay was 10(7-15) d.Postoperative adjuvant chemotherapy FOLFOX6/XELOX+ bevacizumab was performed.The follow-up time was 22(6-42) months.One patient suffered from residual liver metastasis,1 case of lung metastasis,and 1 case of death due to multiple systemic metastases were observed during the follow-up.No recurrence or metastasis was observed in other patients.Conclusions One-stage laparoscopic radical resection of colorectal cancer combined with extensive hepatectomy is a safe and feasible therapy for patients with synchronal liver metastasis from colorectal cancer.更多还原