【摘要】：背景:大腸癌是胃腸道常見(jiàn)的惡性腫瘤,目前全世界的發(fā)病率處于上升狀態(tài)。若不加以治療,患者的5年生存率僅有0-5%。研究表明,大約1/3的患者在首次診斷為大腸癌時(shí),已有同期轉(zhuǎn)移。其中50%的患者表現(xiàn)為肝轉(zhuǎn)移,這也是大腸癌治療效果欠佳的主要原因。目前手術(shù)切除原發(fā)灶及肝轉(zhuǎn)移灶是大腸癌肝轉(zhuǎn)移的主要治療方式。射頻消融治療(RFA)、經(jīng)皮無(wú)水酒精注射(PEI)、乙酸注射、微波凝固術(shù)以及經(jīng)導(dǎo)管動(dòng)脈化療栓塞(TACE)等替代治療亦取得了較好的治療效果。系統(tǒng)化療作為治療惡性腫瘤的傳統(tǒng)方法,也被廣泛用于大腸癌的治療。方法:病例1患者為48歲男性,因"查體發(fā)現(xiàn)肝占位并直腸占位1周"入院,住院期間行腹腔鏡下直腸癌根治術(shù)+肝左外葉切除+肝右葉腫瘤切除+射頻消融術(shù),術(shù)中取肋緣下切口切除病灶并腹腔鏡輔助斷端吻合,術(shù)后2年出現(xiàn)肝復(fù)發(fā)灶,在外院接受20個(gè)周期系統(tǒng)化療、一次手術(shù)治療、多次射頻消融術(shù)及無(wú)水酒精注入術(shù)等,存活4年1個(gè)月。病例2患者為48歲男性,因"腹瀉半年,粘液血便2個(gè)月"入院,住院期間行腹腔鏡下直腸癌前切除術(shù)+左半肝切除術(shù),術(shù)后隨訪8年2個(gè)月,期間患者未出現(xiàn)復(fù)發(fā)和轉(zhuǎn)移灶,且能夠正常生活和工作。兩位患者均在同期診斷為大腸癌肝轉(zhuǎn)移,并先后接受了大腸癌肝轉(zhuǎn)移的腹腔鏡同期切除。不同的是,病例1患者在術(shù)后接受了多次化療、RFA、PEI等治療,術(shù)后僅生存了 4年余;病例2患者在術(shù)后未接受任何其他治療,術(shù)后隨訪達(dá)8年余。通過(guò)收集兩例大腸癌肝轉(zhuǎn)移患者的臨床資料,對(duì)其檢查結(jié)果和治療進(jìn)行比較,結(jié)合相關(guān)研究和文獻(xiàn)進(jìn)行分析,結(jié)果提示大腸癌肝轉(zhuǎn)移原發(fā)灶及肝轉(zhuǎn)移灶如果能同時(shí)手術(shù)切除應(yīng)當(dāng)同期手術(shù)切除,腹腔鏡手術(shù)或腔鏡輔助能夠減輕手術(shù)創(chuàng)傷。我們一例病人的臨床資料提示大腸癌肝轉(zhuǎn)移手術(shù)完整切除后不做進(jìn)一步輔助治療亦可能取得長(zhǎng)期生存。結(jié)論:根據(jù)對(duì)相關(guān)文獻(xiàn)及研究進(jìn)展匯總,結(jié)合兩例個(gè)案的臨床資料支持,我們認(rèn)為大腸癌肝轉(zhuǎn)移的患者如能同時(shí)將原發(fā)灶和肝轉(zhuǎn)移灶切除應(yīng)首選一期手術(shù)切除,且腹腔鏡輔助同期一個(gè)切口切除原發(fā)灶和肝轉(zhuǎn)移灶是可行的;針對(duì)選擇性大腸癌肝轉(zhuǎn)移患者,術(shù)后無(wú)相關(guān)輔助治療亦可能獲得長(zhǎng)期生存效果。
[Abstract]:Background: colorectal cancer is a common malignant tumor in the gastrointestinal tract. If left untreated, the 5-year survival rate was only 0-5%. Studies have shown that about a third of patients had metastases at the same time when they were first diagnosed with colorectal cancer. Liver metastases were found in 50% of the patients, which was the main reason for the poor treatment of colorectal cancer. At present, surgical resection of primary tumor and liver metastasis is the main treatment of liver metastasis of colorectal cancer. Radiofrequency catheter ablation (RFCA) for the treatment of (RFA), with percutaneous anhydrous alcohol injection of (PEI), acetic acid, microwave coagulation and transcatheter arterial chemoembolization (TACE) has also achieved good results. Systemic chemotherapy, as a traditional method for the treatment of malignant tumors, is also widely used in the treatment of colorectal cancer. Methods: case 1, a 48-year-old male, was admitted to hospital for "1 week of liver mass and rectal space occupation". Laparoscopic radical resection of rectal cancer was performed with radiofrequency ablation in the left lateral lobe of the liver, resection of the right lobe of the liver, and resection of the tumor in the right lobe of the liver. Intraoperative subcostal incision was used to remove the lesion and laparoscope assisted end-to-end anastomosis. Liver recurrence occurred 2 years after operation. 20 cycles of systemic chemotherapy, one operation, multiple radiofrequency ablation and anhydrous alcohol injection were performed in the external hospital. Survival 4 years and 1 month. Case 2 was a 48-year-old male who was admitted to hospital because of "diarrhea for half a year, mucous stool for 2 months". Laparoscopic anterior resection of the rectal cancer was performed during hospitalization. The patients were followed up for 8 years and 2 months, during which no recurrence or metastasis was found. And be able to live and work normally. Both patients were diagnosed with liver metastasis of colorectal cancer at the same time and underwent laparoscopic simultaneous resection of liver metastasis of colorectal cancer. The difference was that case 1 received multiple chemotherapy and RFAP PEI and survived for more than 4 years. Case 2 received no other treatment after operation and was followed up for more than 8 years. The clinical data of two patients with liver metastasis of colorectal cancer were collected, the results of examination and treatment were compared, and the related research and literature were analyzed. The results suggest that if the primary liver metastases and liver metastases of colorectal cancer can be resected simultaneously, the surgical trauma can be alleviated by laparoscopy or laparoscopy. The clinical data of one patient suggest that long-term survival may be achieved without further adjuvant therapy after complete resection of liver metastases from colorectal cancer. Conclusion: according to the summary of relevant literature and research progress, combined with the clinical data of two cases, we believe that the primary tumor and liver metastases should be removed first if the patients with liver cancer metastasis can be removed at the same time. Laparoscopically assisted simultaneous resection of primary focus and hepatic metastases is feasible, and no associated adjuvant therapy may be effective for long term survival in patients with selective liver metastasis of colorectal cancer.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.34

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