同期肝切除联合经膈肌入路胸腔镜下肺楔形切除治疗肝肺同时性转移癌3例分析并文献复习
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摘要
目的探讨同期肝切除联合经膈肌入路胸腔镜下肺楔形切除治疗肝肺同时性转移癌的可行性及安全性。方法回顾性分析2017年5—6月北京大学肿瘤医院同期行肝切除联合经膈肌入路胸腔镜下肺楔形切除3例病人的临床资料,通过手术相关指标和随访资料评价疗效。结果 3例病人均成功完成同期肝切除及肺切除术,其中肝切除时间分别为82、50、43 min,出血量分别为400、150、200 mL;肺切除时间分别为45、60、36 min,肺切除过程中的出血量分别为10、30、5 mL。无围手术期死亡及严重并发症发生。结论对于可切除的肝肺同时性转移的病人,同期肝切除联合经膈肌入路胸腔镜下肺楔形切除安全可行。
Objective To investigate the feasibility and safety of simultaneous liver section combined with pulmonary wedge resection via the trans-diaphragmatic approach in patients of synchronous liver and lung metastases. Methods The clinical data of 3 patients of synchronous liver and lung metastases who underwent simultaneous liver section combined with pulmonary wedge resection via the trans-diaphragmatic approach at Peking University Cancer Hospital between May 2017 and June 2017 were retrospectively analyzed. Results All liver and lung metastases of 3 patients were successfully resected. Operation time for liver resections were 82, 50 and 43 min, while blood losses were 400, 150 and 200 mL respectively. Meanwhile, operation time for pulmonary resections were 45, 60 and 36 min, and blood losses were 10, 30 and 5 mL respectively. Neither perioperative death nor severe complication occurred. Conclusion Simultaneous liver resection combined with pulmonary wedge resection via the trans-diaphragmatic approach is a safe technique for the patients with resectable synchronous liver and lung metastases
Objective To investigate the feasibility and safety of simultaneous liver section combined with pulmonary wedge resection via the trans-diaphragmatic approach in patients of synchronous liver and lung metastases. Methods The clinical data of 3 patients of synchronous liver and lung metastases who underwent simultaneous liver section combined with pulmonary wedge resection via the trans-diaphragmatic approach at Peking University Cancer Hospital between May 2017 and June 2017 were retrospectively analyzed. Results All liver and lung metastases of 3 patients were successfully resected. Operation time for liver resections were 82, 50 and 43 min, while blood losses were 400, 150 and 200 mL respectively. Meanwhile, operation time for pulmonary resections were 45, 60 and 36 min, and blood losses were 10, 30 and 5 mL respectively. Neither perioperative death nor severe complication occurred. Conclusion Simultaneous liver resection combined with pulmonary wedge resection via the trans-diaphragmatic approach is a safe technique for the patients with resectable synchronous liver and lung metastases
引文
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[7]Alassar A,Bello SO,Rahamim J.Novel approach to drainage of a right subphrenic abscess using trans-diaphragmatic laparoscopy[J].Ann R Coll Surg Engl,2015,97(7):543.
[8]Golse N,Ducerf C,Rode A,et al.Transthoracic approach for liver tumors[J].J Visc Surg,2012,149(1):e11-e22.
[9]Mineo TC,Ambrogi V,Paci M,et al.Transxiphoid bilateral palpation in video-assisted thoracoscopic lung metastasectomy[J].Arch Surg,2001,136(7):783-788.
[10]Mise Y,Mehran RJ,Aloia TA,et al.Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases[J].Surgery,2014,156(5):1197-1203.
[11]Nakajima J.Pulmonary metastasis:rationale for local treatments and techniques[J].Gen Thorac Cardiovasc Surg,2010,58(9):445-451.
[12]Kim HK.Pulmonary metastasectomy for colorectal cancer:How many nodules,how many times?[J].World J Gastroenterol,2014,20(20):6133.
[13]Takasu C,Shimada M,Sato H,et al.Benefits of simultaneous laparoscopic resection of primary colorectal cancer and liver metastases[J].Asian J Endosc Surg,2014,7(1):31-37.
[14]Xu J M,Wei Y,Wang XY,et al.Robot-assisted one-stage resection of rectal cancer with liver and lung metastases[J].World J Gastroenterol,2015,21(9):2848-2853.
[2]中华医学会外科学分会胃肠外科学组,中华医学会外科学分会结直肠肛门外科学组,中国抗癌协会大肠癌专业委员会,等.结直肠癌肝转移诊断和综合治疗指南(2016)[J].中国实用外科杂志,2016,36(8):858-869.
[3]National Comprehensive Cancer Network.Clinical practice guidelines in oncology.colon cancer,version 2.2017[Z].[2018-03-02]http://www.jnccn.org/content/15/3/370.short.
[4]Van Cutsem E,Cervantes A,Adam R,et al.ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J].Ann Oncol,2016,27(8):1386-1422.
[5]Brouquet A,Vauthey JN,Contreras CM,et al.Improved survival after resection of liver and lung colorectal metastases compared with liver-only metastases:a study of 112 patients with limited lung metastatic disease[J].J Am Coll Surg,2011,213(1):62-71.
[6]Rodriguez-Aldrete D,Candiotti KA,Janakiraman R,et al.Trends and new evidence in the management of acute and chronic post-thoracotomy pain-an overview of the literature from2005 to 2015[J].J Cardiothorac Vasc Anesth,2016,30(3):762-772.
[7]Alassar A,Bello SO,Rahamim J.Novel approach to drainage of a right subphrenic abscess using trans-diaphragmatic laparoscopy[J].Ann R Coll Surg Engl,2015,97(7):543.
[8]Golse N,Ducerf C,Rode A,et al.Transthoracic approach for liver tumors[J].J Visc Surg,2012,149(1):e11-e22.
[9]Mineo TC,Ambrogi V,Paci M,et al.Transxiphoid bilateral palpation in video-assisted thoracoscopic lung metastasectomy[J].Arch Surg,2001,136(7):783-788.
[10]Mise Y,Mehran RJ,Aloia TA,et al.Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases[J].Surgery,2014,156(5):1197-1203.
[11]Nakajima J.Pulmonary metastasis:rationale for local treatments and techniques[J].Gen Thorac Cardiovasc Surg,2010,58(9):445-451.
[12]Kim HK.Pulmonary metastasectomy for colorectal cancer:How many nodules,how many times?[J].World J Gastroenterol,2014,20(20):6133.
[13]Takasu C,Shimada M,Sato H,et al.Benefits of simultaneous laparoscopic resection of primary colorectal cancer and liver metastases[J].Asian J Endosc Surg,2014,7(1):31-37.
[14]Xu J M,Wei Y,Wang XY,et al.Robot-assisted one-stage resection of rectal cancer with liver and lung metastases[J].World J Gastroenterol,2015,21(9):2848-2853.