本文選題：結(jié)直腸癌同時性肝轉(zhuǎn)移　切入點：同期手術(shù)　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:過去幾十年,結(jié)直腸癌在我國發(fā)病率逐漸升高,大約15%-25%的結(jié)直腸癌病人在明確診斷時就合并有肝轉(zhuǎn)移,另有15%-25%的結(jié)直腸癌病人在原發(fā)灶進行根治手術(shù)后發(fā)展成肝轉(zhuǎn)移,手術(shù)R0切除原發(fā)灶和轉(zhuǎn)移灶是可能治愈結(jié)直腸癌肝轉(zhuǎn)移的最佳手段。目前對于初始可切除的結(jié)直腸癌同時性肝轉(zhuǎn)移病人采取同期手術(shù)切除還是分期手術(shù)切除仍有爭議。本研究分析同期手術(shù)切除與先腸后肝手術(shù)切除的安全性和近遠期效果,從而為臨床醫(yī)生選擇最佳手術(shù)時機和手術(shù)模式來治療結(jié)直腸癌同時性肝轉(zhuǎn)移提供思緒和理論依據(jù)。方法:回顧性分析吉林大學(xué)中日聯(lián)誼醫(yī)院2006年9月-2011年9月收治的71名初始可切除的結(jié)直腸癌同時性肝轉(zhuǎn)移患者,其中33名同期手術(shù)切除(同期手術(shù)組),38名患者先腸后肝手術(shù)切除(先腸后肝組)。分析比較兩組患者在術(shù)中出血量、手術(shù)時間、術(shù)后并發(fā)癥的發(fā)生率、總住院時間以及生存率之間的差異。結(jié)果:兩組患者均平穩(wěn)出院。同期手術(shù)組術(shù)中平均出血量為476.64±118.33ml,先腸后肝組為559.55±111.78ml,同期手術(shù)組平均手術(shù)時間229.81±19.33min,先腸后肝組261.92±21.97min,同期手術(shù)組平均總住院時間16.97±1.99d,先腸后肝組平均總住院時間19.71±2.64d,兩組相比同期手術(shù)組優(yōu)于先腸后肝組,差異具有統(tǒng)計學(xué)意義(р0.05)。同期手術(shù)組術(shù)后并發(fā)癥發(fā)生率為24.2%,先腸后肝組為18.4%,雖同期手術(shù)組并發(fā)癥發(fā)生率高于先腸后肝組,但差異不具有統(tǒng)計學(xué)意義(р0.05)。同期手術(shù)組中位生存時間為35m,先腸后肝組為38m,同期手術(shù)組1、3、5年生存率分別為90.9%、48.5%、30.3%,先腸后肝組分別為89.5%、52.6%、28.9%,兩組相比差異不具有統(tǒng)計學(xué)意義,遠期效果相當(dāng)。結(jié)論:同期手術(shù)治療初始可切除的結(jié)直腸癌同時性肝轉(zhuǎn)移患者是安全有效的,同期手術(shù)與先腸后肝手術(shù)相比能降低術(shù)中出血量、手術(shù)時間、總住院時間,具有社會經(jīng)濟學(xué)效益,值得推廣。
[Abstract]:Objective: over the past few decades, the incidence of colorectal cancer in our country increased gradually, about 15%-25% of patients with colorectal cancer at the time of diagnosis is associated with liver metastasis, and 15%-25% colorectal cancer patients after radical surgery developed liver metastasis in primary tumor, R0 resection of primary and metastatic is possible the best way to cure with liver metastasis of colorectal cancer. The initial resectable colorectal cancer and liver metastasis treated by simultaneous resection or staging surgery remains controversial. This study analyzed the simultaneous resection and surgical resection of the liver after intestinal safety and short term effect, thus for the treatment of colorectal cancer with synchronous liver transfer offers ideas and theoretical basis for clinicians to select the optimal operation timing and operative mode. Methods: a retrospective analysis of the September 2006 Sino Japanese Friendship Hospital of Jilin University -2011 admitted in September 71 The initial resectable colorectal cancer patients with simultaneous liver metastasis, including 33 surgical resection (operative group), liver resection in 38 patients after the first bowel (liver group after intestinal bleeding). Analysis and comparison of two groups of patients in the operative time, postoperative complication rate, hospitalization the difference between time and survival. Results: two patients were discharged smoothly. The operative group average intraoperative bleeding volume was 476.64 + 118.33ml, the first bowel after liver group was 559.55 + 111.78ml, the operative group average operation time was 229.81 + 19.33min, 261.92 + 21.97min group after first liver intestinal surgery group over the same period, the average total the hospitalization time was 16.97 + 1.99d, the first bowel after liver group the average hospitalization time was 19.71 + 2.64d, two groups of liver surgery group group is better than the first bowel, the difference was statistically significant (P 0.05). The complication rate was 24.2% over the same period after surgery group, the first group was 18.4% after liver intestine, Although the operative group group of liver complications than the first bowel, but the difference was not statistically significant (P 0.05). The operative group the median survival time was 35m, the first bowel after liver group was 38m, the operative group 1,3,5 year survival rates were 90.9%, 48.5%, 30.3%, the first bowel after liver component for 89.5%, 52.6%, 28.9%, the difference between the two groups was not statistically significant, long-term effect. Conclusion: colorectal cancer surgery over the same period the initial resection of synchronous liver metastases is safe and effective, and the first operative intestinal after liver surgery compared to reduce blood volume, the operative time, total hospitalization time has benefits, social economics, and is worthy of promotion.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34

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