【作者】 周彬；

【导师】 曹宏；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2018， 硕士

【摘要】 目的:结直肠癌是我国常见的恶性肿瘤之一,居恶性肿瘤发病率的第三位,总体发病率呈上升的趋势。肝脏是其最常见的转移部位,也是致死的主要原因。随着对结直肠癌肝转移(colorectal cancer liver metastases,CRLM)研究的深入,形成了许多国际共识和指南。然而时至今日仍然存在这许多争议性的问题,先化疗还是先手术治疗可切除结直肠癌同时性肝转移就是其争议问题之一。本文研究分析了可切除结直肠癌同时性肝转移患者两种治疗模式下手术安全性、局部复发率以及生存率之间的差异,从而为广大同仁在治疗CRLM方面提供思路和理论参考。方法:回顾性分析吉林大学中日联谊医院2010年9月-2012年9月收治的51名可切除的结直肠癌同时性肝转移患者,其中28名患者先同期手术切除,随后行术后化疗(先手术组),23名患者先新辅助化疗,随后再行手术切除联合术后化疗(先化疗组)。分析比较两组患者在手术安全性、局部复发率以及生存率之间的差异。结果:先手术组平均总出血量为312.14±12.06ml,先化疗组平均总出血量为313.91±13.10ml;先手术组平均手术时间为245.00±7.32min,先化疗组平均手术时间为246.96±8.56min;先手术组的手术并发症发生率为21.43%,先化疗组的手术并发症发生率为21.73%;两组数据相比差异没有统计学意义(P>0.05),在手术安全性方面相当。先手术组1年、3年和5年的局部复发率分别为25.00%、46.43%和85.71%;先化疗组1年、3年和5年的局部复发率分别为21.74%、43.48%和82.61%;两组数据相比,差异没有统计学意义(P>0.05),复发率相当。先手术组的1年、3年和5年生存率分别为96.43%、46.43%和39.29%,先化疗组的1年、3年和5年生存率分别为95.65%、52.17%和39.13%,两组数据相比,差异没有统计学意义(P>0.05),生存率相当。结论:先手术与先化疗治疗可切除结直肠癌同时性肝转移患者的手术安全性、局部复发率以及生存率效果相当,手术时机的选择应该通过多学科综合治疗协作团队(multidisciplinary team,MDT)对患者进行全面评估,个体化制定治疗目标,选取最佳的综合治疗手段。更多还原

【Abstract】 Objective:Colorectal cancer is one of the most common maligant tumors in China,occupying the third place of the incidence of maligant tumors and the incidence is on the rise.The liver is the most common metastatic site and is the leading cause of death.With the in-depth study of colorectal cancer of liver metastases(CRLM),many international consensus and guidelines have been developed.However,there is still a lot of controversial issues to this day.First surgery and primary chemotherapy is one of the most controversial issues.This article studied and analyzed the surgical safety,local recurrence rate and survival rate of patients with resectable colorectal cancer synchronous liver metastasis in the two treatment modalities,so as to provide ideas and theoretical reference for the majority of my colleagues in the treatment of CRLM.Methods:Retrospective analysis of 51 patients with resectable colorectal cancer synchronous liver metastasis from September 2010 to September 2012 in the China-Japan Union Hospital of Jilin University.Among them,28 patients underwent simultaneously surgical resection and then postoperative chemotherapy(first Surgery group).23 patients received neoadjuvant chemotherapy followed by surgical resection combined with postoperative chemotherapy(first chemotherapy group).Analysis of the two groups of patients in the safety of surgery,the local recurrence rate and the difference between the survival rate.Results:The average total blood loss of the first surgery group was 312.14 ± 12.06 ml,and the average total blood loss of the first chemotherapy group was 313.91 ± 13.10 ml.The mean operation time of the first surgery group was 245.00 ± 7.32 min,and the average operation time of the first chemotherapy group was 246.96 ± 8.56 min.The incidence of surgical complications in the first surgery group was 21.43%.The incidence of surgical complications in the first chemotherapy group was 21.73%.There was no significant difference between the two groups(P> 0.05).The local recurrence rates in the first operation group were 25.00%,46.43% and 85.71% at one year,three years and five years respectively.The local recurrence rates of the first chemotherapy group at one year,three years and five years respectively,21.74%,43.48% and 82.61%.There was no significant difference between the two groups(P> 0.05).The recurrence rate was comparable.The 1-year,3-year and 5-year survival rates of the first surgery group were 96.43%,46.43% and 39.29%.The 1-,3-and 5-year survival rates of the first chemotherapy group were 95.65%,52.17% and 39.13% There was no significant difference between the two groups(P> 0.05),and the survival rate was comparable.Conclusion:Surgical safety,local recurrence,and survival are comparable in patients who have undergone first surgery and primary chemotherapy for concurrent resectable colorectal cancer synchronous liver metastasis.The timing of the surgery should be evaluated by the multidisciplinary team(MDT)conduct a comprehensive assessment,individualized treatment goals,select the best combination of treatment.更多还原