切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (04): 239 -242. doi: 10.3877/cma.j.issn.1674-6899.2023.04.008

临床技术

腹腔镜解剖性肝右后叶切除治疗食管癌根治术后孤立性肝转移
高加林, 曹亚娟()   
  1. 210008 江苏,南京大学医学院附属鼓楼医院普通外科肝胆与肝移植外科
  • 收稿日期:2023-05-19 出版日期:2023-08-30
  • 通信作者: 曹亚娟

Anatomical laparoscopic right posterior lobectomy for isolated liver metastases after radical esophageal cancer resection

Jialin Gao, Yajuan Cao()   

  1. Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Jiangsu 210008, China
  • Received:2023-05-19 Published:2023-08-30
  • Corresponding author: Yajuan Cao
目的

总结腹腔镜解剖性肝切除治疗食管癌术后孤立性肝转移的临床效果及优势。

方法

回顾性分析2023年2月在南京大学医学院附属鼓楼医院肝胆外科收治的1例食管癌根治术后5月出现孤立性肝转移患者的病历资料,该患者经多西紫杉醇、顺铂及5-氟尿嘧啶(DCF方案)联合化疗4个周期,化疗期间出现右肝病灶,并逐渐增大,排除手术禁忌后行腹腔镜下解剖性肝右后叶切除。

结果

患者顺利接受腹腔镜下解剖性肝右后叶切除治疗,术中出血少,术后无腹腔感染、出血、胆瘘等并发症,恢复顺利,术后病理结果符合食管癌肝转移。术后6月随访,患者恢复良好,术后在当地医院继续系统化疗3个周期,无复发、无进展。

结论

食管癌术后孤立性肝转移经腹腔镜微创切除的局部手段,联合全身系统化疗,能够改善患者预后,提高生存率,延长生存期。

Objective

To summarize the clinical efficacy and advantages of laparoscopic hepatectomy for solitary liver metastases after radical esophageal cancer resection.

Methods

A retrospective analysis was performed for a patient with isolated liver metastases in the Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, in Feb. 2023. Whose right liver lesion was slowly enlarged during 4 cycles of chemotherapy by DCF (docetaxel, cisplatin and 5-fluorouracil) regimen, and then the anatomical laparoscopic right posterior lobectomy were performed.

Results

The patient successfully underwent laparoscopic anatomical right posterior lobe resection of the liver, with less intraoperative bleeding, no postoperative complications such as infection, bleeding, and biliary fistula, and recovered smoothly. The postoperative pathological examination was consistent with the liver metastasis of esophageal cancer. The patient recovered well 6 months after surgery, no recurrence or progression, and continued systematic chemotherapy in the local hospital for 3 cycles.

Conclusion

The laparoscopic minimally invasive resection of solitary liver metastases after oesophageal cancer resection, combined with systemic chemotherapy, improves prognosis and progression-free survival.

图1 辅助检查结果注:A-B.内镜下食管吻合口;C.全身ECT骨显像;D-G.肝脏S7病灶的磁共振平扫T2像及强化表现。
图2 手术步骤、标本情况及术后病理注:A.探查腹腔、松解粘连、游离肝周韧带;B.预置肝门阻断带;C.显露肝静脉陷窝;D.游离并阻断右后肝蒂;E.沿缺血线标记切肝线;F.游离肝实质,显露S7肝蒂及回流静脉根部并离断;G.切除标本;H.病理HE染色。
1
Liu Z, Suo C, Mao X, et al. Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017[J]. Cancer, 2020, 126(10):2267-2278.
2
Chang A, Ganz P, Hayes D, el al. Oncology: an evidence-based approach[M]. New York: Springer, 2006:449-486.
3
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.
4
Shindoh J. Risk stratification and goal of systemic therapy for successful surgical management of colorectal liver metastases: Oncological optimization[J]. J Hepatobiliary Pancreat Sci, 2021, 28(6):461-469.
5
Yamamoto M, Yoshida M, Furuse J, et al. Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021[J]. J Hepatobiliary Pancreat Sci, 2021, 28(1):1-25.
6
王鲁. 转移性肝癌的外科治疗[J]. 肝胆外科杂志2017, 25(4):305-307.
7
中华医学会外科分会胃肠外科学组,中华医学会外科分会结直肠外科学组,中国抗癌协会大肠癌专业委员会,等. 中国结直肠癌肝转移诊断和综合治疗指南(V 2018)[J/CD]. 中华结直肠疾病电子杂志2018(4):302-314.
8
中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)结直肠癌诊疗指南[M]. 北京:人民卫生出版社,2022:64-67.
9
National Comprehensive Cancer Network. Recent updates to NCCN clinical practice guidelines in oncology-colon cancer(version 4.2020) and rectal cancer (version 1.2020) [DB/OL].

URL    
10
中华医学会外科学分会胰腺外科学组. 胰腺神经内分泌肿瘤治疗指南(2014)[J]. 中华肝胆外科杂志201420(12):841-844.
11
Partelli S, Bartsch DK, Capdevila J, et al, ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours[J]. Neuroendocrinology, 2017, 105(3):255-265.
12
Pavel M, Öberg K, Falconi M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2020, 31(7):844-860.
13
Kurihara T, Itoh S, Kimura Y, et al. Feasibility of hepatic resection for liver metastasis of head-and-neck carcinoma or esophageal carcinoma: a multi-center experience[J]. Surg Today, 2021, 51(12):1932-1937.
14
Pawlik TM, Gleisner AL, Bauer TW, et al. Liver-directed surgery for metastatic squamous cell carcinoma to the liver: results of a multi-center analysis[J]. Ann Surg Oncol, 2007, 14(10):2807-2816.
15
Ai D, Zhu H, Ren W, et al. Patterns of distant organ metastases in esophageal cancer: a population-based study[J]. J Thorac Dis, 2017, 9(9):3023-3030.
16
Zhang S, Guo J, Zhang H, et al. Metastasis pattern and prognosis in men with esophageal cancer patients: a SEER-based study. Medicine (Baltimore)[J]. 2021, 100(25):e26496.
17
Li H, Zhang S, Guo J, et al. Hepatic metastasis in newly diagnosed esophageal cancer: a population-based study[J]. Front Oncol, 2021, 11:644860.
18
Adam R, Chiche L, Aloia T, et al. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model[J]. Ann Surg, 2006, 244(4):524-535.
19
Ichida H, Imamura H, Yoshimoto J, et al. Pattern of postoperative recurrence and hepatic and/or pulmonary resection for liver and/or lung metastases from esophageal carcinoma[J]. World J Surg, 2013, 37(2):398-407.
20
Liu J, Wei Z, Wang Y, et al. Hepatic resection for post-operative solitary liver metastasis from oesophageal squamous cell carcinoma[J]. ANZ J Surg, 2018, 88(4):E252-E256.
21
Urabe M, Yagi K, Shiomi S, et al. Implications of liver-directed therapy for postoperative hepatic metastasis from esophageal cancer[J]. J Chest Surg, 2022, 55(5):397-404.
22
曹亚娟,黎兵华,余德才. 转化治疗联合Laennec入路机器人右半肝切除治疗进展期肝癌[J/CD]. 中华腔镜外科杂志(电子版), 2023, 16(2): 116-119.
[1] 燕速. 腹腔镜低位直肠癌盆腔侧方淋巴结清扫指征与策略[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 480-484.
[2] 常剑, 邱峰, 毛郁琪. 摄食抑制因子-1与腹腔镜结直肠癌根治术后肝转移的关系分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 502-505.
[3] 陈滔, 罗洪, 周进军. 老年食管癌单纯放疗及同期放化疗患者急性不良反应影响因素分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 405-407.
[4] 刘恒, 侯宇川. 膀胱癌新型灌注药物的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 445-451.
[5] 徐天亮, 程干思, 吴亚平, 龚荣, 胡洁, 段群娣, 李承慧. 奥希替尼联合安罗替尼二线治疗转移性NSCLC的疗效分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 520-522.
[6] 李斌奎. 不可切除肝内胆管细胞癌的转化治疗[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 511-516.
[7] 黄洁. 腹腔镜肝脏手术中一些值得深入思考的问题[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 267-271.
[8] 刘玉星, 刘晨鸣, 杜金林. 初始不可切除的结直肠癌肝转移转化治疗的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 337-341.
[9] 李绍堂. 直肠癌侧方淋巴结清扫的关键问题探讨[J]. 中华结直肠疾病电子杂志, 2023, 12(03): 190-195.
[10] 刘代江, 蒋俊艳, 万晓强, 马莎英. 结直肠癌肝转移患者生存状况及预后影响因素分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 284-288.
[11] 苏鹏, 吕会来, 温士旺, 黄超, 张缜, 田子强. 全腔镜下食管癌根治术围手术期呼吸系统并发症发生的危险因素分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 294-298.
[12] 曹旬旬, 费素娟. 食管癌患者肿瘤组织CXCL5和CXCR2的表达与病情和预后的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 299-304.
[13] 孔凡彪, 杨建荣. 肝脏基础疾病与结直肠癌肝转移之间关系的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(07): 818-822.
[14] 牛文博, 吴凤鹏, 刘月平, 周超熙, 张娟, 胡旭华, 李保坤, 王贵英. 新辅助放化疗对局部进展期直肠癌疗效及肿瘤免疫微环境变化的研究[J]. 中华临床医师杂志(电子版), 2023, 17(05): 519-523.
[15] 陈柯豫, 黄艳齐, 张玲利. 同时性多发早期食管癌及高级别上皮内瘤变的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(05): 524-528.
阅读次数
全文


摘要