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| 1 | 腹腔镜结直肠原发灶和肝转移灶同步切除术在同时性结直肠癌肝转移患者中应用的疗效分析显示文摘目的探讨可切除的同时性结直肠癌肝转移患者接受腹腔镜原发灶和肝转移灶同步切除手术的近期疗效。方法采用描述性病例系列研究方法,从复旦大学附属中山医院前瞻性收集管理的结直肠癌数据库中,选取2015年12月至2018年9月期间接受腹腔镜结直肠癌原发灶和肝转移灶同步切除手术的53例同时性结直肠癌肝转移患者的临床资料,分析围手术期情况及近期疗效。结果全组患者年龄(61.7±11.3)岁,其中男性32例(60.4%),女性21例(39.6%);美国麻醉医师协会(ASA)评分:Ⅰ级25例(47.2%),Ⅱ级28例(52.8%)。全组患者均顺利完成腹腔镜结直肠原发灶和肝转移灶同步切除手术,无中转开腹者;同步切除的手术时间(320.2±114.5)min。术中失血量150.0(45.0~2000.0)ml,其中仅2例(3.8%)行术中输血。术后病理显示:原发灶肿瘤长径(5.4±1.9)cm;T1~2期4例(7.5%),T3~4期48例(90.6%);40例(75.5%)有淋巴结转移;19例(35.8%)有脉管累及,24例(45.3%)有神经侵犯。同步切除肝转移灶中位数1.0(1~8)个,肝转移灶最大径(3.0±1.9)cm,肝转移灶切缘1.0(0.1~3.5)cm,仅1例为R1切除。术后首次排气时间(67.9±28.9)h,恢复流质饮食时间为(107.0±33.8)h,术后留置导尿时间(85.6±56.4)h,术后住院时间(9.2±4.4)d,住院费用(8.2±2.6)万元。全组患者均无术后30 d死亡,术后并发症发生率32.1%(17/53),其中Ⅲ~Ⅳ级严重并发症3例。所有并发症均经保守治疗好转。中位随访23.2个月,19例(35.8%)患者发生复发转移,4例(7.5%)死亡。术后1年和2年无病生存率分别为68%和47%,术后1年和2年总体生存率分别为95%和86%。结论腹腔镜同步切除结直肠癌原发灶和肝转移灶在同时性结直肠癌肝转移患者中安全可行,术后胃肠道功能恢复较快,并发症发生率在可接受范围内,肿瘤学结果满意。 | 朱德祥 何国栋 毛翌皓 韦烨 任黎 林奇 王晓颖 许剑民 | 2020 | 中华胃肠外科杂志2020，23，6： | 12 |
| 2 | 结直肠癌肝转移的外科治疗进展显示文摘据美国癌症协会2019年的研究数据显示,在全世界范围内的肿瘤性疾病中,结直肠癌的发病率和病死率均居第3位,仅2018年全球就有超过180万新发病例。而中国2015年结直肠癌新发病例高达38.8万,其中死亡18.7万例[1]。肝脏是结直肠癌远处转移最常见的靶器官,肝转移灶的治疗是结直肠癌患者治疗的重中之重,目前认为,手术完全切除肝转移灶是结直肠癌肝转移(colorectal liver metastasis,CRLM)患者唯一可能的治愈手段,也是改善患者预后的最佳方案。本文将对近年来国内外CRLM外科治疗的现状与进展进行阐述。 | 刘聪 毛家玺 滕飞 | 2020 | 中华肝脏外科手术学电子杂志2020，9，4： | 6 |
| 3 | Repeat hepatectomy for recurrent colorectal liver metastases:A comparative analysis of short-and long-term results显示文摘Background: Liver recurrence after resection of colorectal liver metastases(CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefts for patients with early recurrence have not been clarifed. The aim of this study was to compare the short-and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared. Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 20 0 0 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy. Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4(3-6) vs. 3(2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies(34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions resected(2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival( P = 0.626) and disease-free survival( P = 0.579) between the two groups. Similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival( P = 0.771) or disease-free survival( P = 0.350). Conclusions: Repeat hepatectomy is feasible and safe, with similar short-and long-term outcomes when compared to single hepatectomy. Surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence. | Paulo Figueiredo Costa Fabricio Ferreira Coelho Vagner Birk Jeismann Jaime Arthur Pirola Kruger Gilton Marques Fonseca Ivan Cecconello Paulo Herman | 2022 | Hepatobiliary & Pancreatic Diseases International2022，21，2： | 2 |
| 4 | 肝切除和微波消融治疗结直肠癌肝转移的效果比较显示文摘目的比较肝切除和微波消融(microwave ablation,MWA)治疗结直肠癌肝转移(CRLM)的疗效。方法回顾性分析2013年1月至2020年7月98例CRLM患者的临床资料,根据治疗方法不同分为2组,肝切除组31例,MWA组67例。MWA组共治疗105个病灶,其中特殊部位病灶36个,非特殊部位病灶69个。Kaplan-Meier法绘制生存曲线,Log-rank(Mantel-Cox)检验比较两组肿瘤复发率和生存差异。χ^(2)检验比较两组消融不完全率,单因素和多因素Logistic回归分析消融不完全的危险因素。结果随访截止2020年10月30日,中位随访时间38(4~94)个月。肝切除组中位肝内复发时间22(95%CI 13~49)个月,明显长于MWA组9(95%CI 6~12)个月(P<0.001)。肝切除组中位生存时间为60(95%CI 33~86)个月,也明显长于MWA组36(95%CI 30~41)个月(P=0.040)。肝切除组和MWA组1、5年累积生存率无统计学差异(100%vs 97%,χ^(2)=0.945,P=1.000;36%vs 27%,χ^(2)=0.437,P=0.508)。肝切除组3年累积生存率高于MWA组(74%vs 48%,χ^(2)=6.013,P=0.014)。特殊部位组消融不完全率明显高于非特殊部位[33.3%(12/36)vs 15.9%(11/69),χ^(2)=4.183,P=0.041]。肿瘤直径≥3 cm、特殊部位、CEA≥200 ng/mL是消融不完全的危险因素,其中肿瘤直径≥3 cm是消融不完全的独立危险因素。结论可切除性CRLM手术切除的疗效优于微波消融,直径大于3 cm的肿瘤不宜微波消融治疗。 | 周江敏 陈琳 周晨阳 胡新昇 王金林 申雪晗 张志伟 陈孝平 | 2021 | 肝胆胰外科杂志2021，33，7： | 0 |
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