大肠直肠肝转移中的帕伦基马节约策略:一个单一中心的经验
Eleonora Pozzi1, Giuliano La Barba2, Fabrizio D'Acapito2
1Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
Current oncology (Toronto, Ont.)
|January 27, 2026
概括
与主要肝切除术 (MH) 相比,节性肝切除术 (PSH) 为结直肠肝转移 (CRLM) 提供了一种不太病态的方法. PSH导致更好的恢复,并保留了未来肝脏切除的选择.
科学领域:
- 肝胆道手术 肝胆道手术
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 结直肠肝转移 (CRLM) 的重大肝切除术 (MH) 实现了高的R0率,但增加了发病率.
- 帕伦基马节约性肝切除术 (PSH) 旨在减少并发症,同时保持瘤的结果.
- 对于CRLM平衡安全性和有效性的最佳手术策略仍然是一个研究领域.
研究的目的:
- 在CRLM患者中,比较PSH与MH的结果.
- 评估外科手术策略对术后并发症,瘤学结果和长期管理的影响.
- 为了确定不同手术方法后重复肝切除术的可行性.
主要方法:
- 针对CRLM (2016-2025) 进行肝切除的248名患者的回顾性分析.
- 将患者分为PSH (n=215) 和MH (n=33) 组进行分类.
- 多变量考克斯回归分析以确定影响生存和复发的因素.
主要成果:
- 患有较高瘤负担的患者 (较大的病变,更多的转移,双边疾病) 中,MH更频繁.
- PSH与更短的住院时间,更少的并发症和更低的再入院率有关.
- 手术策略没有影响无复发或整体存活率;瘤负担是主要的驱动因素. 在PSH后,重复肝切除术更可行.
结论:
- PSH与手术后发病率降低有关,并促进CRLM患者的早期康复.
- PSH 保持了功能性肝膜,使得随后的肝脏切除可用于复发性疾病.
- PSH为MH提供了一个有价值的替代品,特别是在慢性疾病管理的背景下管理CRLM.
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