两种方法治疗不同直径直肠癌肝转移的效果和影响生存率的因素分析

Effect of two methods on liver metastasis of rectal cancer with different diameter and analysis of factors affecting survival rate

摘要:

目的 探讨超声引导下射频消融术和腹腔镜治疗不同直径直肠癌肝转移的效果和影响生存率的相关因素。方法 回顾性分析2017年1月－2019年12月该院收治的87例行原发癌切除的发生直肠癌肝转移的患者的临床资料，按照不同治疗方法分为两组，观察组（n = 45）采用超声引导下射频消融术治疗，对照组（n = 42）采用腹腔镜手术切除治疗。比较两组患者疗效、肝功能指标变化情况和患者死亡情况，并对死亡与存活患者进行单因素和多因素分析，研究影响其生存的相关因素。结果 观察组病灶灭活率为81.82%，明显高于对照组的52.38%（P < 0.05），观察组大、中、小病灶灭活程度均高于对照组（P < 0.05）；两组患者术后血清白蛋白（ALB）、谷丙转氨酶（GPT）、碱性磷酸酶（ALP）和谷草转氨酶（GOT）等肝功能指标水平均高于术前，术后观察组ALB、GPT和GOT水平均低于对照组（P < 0.05）；观察组总有效率为86.67%，高于对照组的69.05%（P < 0.05）；观察组术后2年内死亡率为15.56%，低于对照组的26.19%（P < 0.05），两组患者不同直径病灶死亡率比较，差异有统计学意义（P < 0.05）；单因素分析发现，直肠癌肝转移患者死亡与病灶大小、术前癌胚抗原（CEA）、肝外转移、TNM分期、组织分型、转移灶数目和转移灶发现时间等因素相关（P < 0.05）；多因素Logistic回归分析发现，术前CEA（OR＾ = 2.117，P = 0.021）、肝外转移（OR＾ = 1.897，P = 0.015）和大病灶（OR＾ = 8.787，P = 0.007）是直肠癌肝转移患者死亡的独立危险因素。结论 超声引导下射频消融术治疗不同直径直肠癌肝转移较腹腔镜治疗效果好，术前CEA、肝外转移和大病灶是影响直肠癌肝转移患者生存的独立危险因素。

Abstract:

Objective To investigate the therapeutic effect and related factors affecting survival rate of ultrasound-guided radiofrequency ablation and laparoscopy in treatment of different diameter metastatic carcinoma of rectal cancer.Methods Clinical data of 87 patients with liver metastasis of rectal cancer from January 2017 to December 2019 were analyzed retrospectively. They were divided into two groups according to different treatment methods. The observation group (n = 45) was treated with ultrasound-guided radiofrequency ablation and the control group (n = 42) was treated with laparoscopic resection. The curative effect, changes of liver function indexes and death of patients were compared between the two groups. The survival and death patients were analyzed by univariate and multivariate analysis to study the related factors affecting their survival.Results The inactivation rate of lesions in the observation group was 81.82%, which was significantly higher than 52.38% in the control group (P < 0.05); The levels of albumin (ALB), glutamic-pyruvic transaminase (GPT), alkaline phosphatase (ALP) and glutamic-oxaloacetic transaminase (GOT) in the two groups were higher than those before the operation, and the levels of ALB, GPT and GOT in the observation group were lower than those in the control group (P < 0.05); The total effective rate in the observation group was 86.67%, which was higher than 69.05% in the control group (P < 0.05); The mortality within 2 years after operation in the observation group was 15.56%, which was less than 26.19% in the control group (P < 0.05). There was significant difference in the mortality of lesions with different diameters between the two groups (P < 0.05); Univariate analysis showed that the death of patients with liver metastasis of rectal cancer was related to lesion size, preoperative carcinoembryonic antigen (CEA), extrahepatic metastasis, TNM stage, histological classification, the number of metastases and the discovery time of metastases (P < 0.05); Logistic multivariate regression analysis showed that preoperative CEA (OR＾ = 2.117, P = 0.021), extrahepatic metastasis (OR＾ = 1.897, P = 0.015) and major lesion (OR＾ = 8.787, P = 0.007) were independent risk factors for death in patients with liver metastasis of rectal cancer.Conclusion Ultrasound-guided radiofrequency ablation is more effective than laparoscopy in treatment of liver metastases with different diameters of rectal cancer. Preoperative CEA, extrahepatic metastasis and large lesions are the influencing factors affecting the survival of patients with liver metastases of rectal cancer.