Ruers T J, Wobbes T, Jager G J
Afd. Heelkunde, Academisch Ziekenhuis St. Radboud, Nijmegen.
Ned Tijdschr Geneeskd. 1998 Nov 7;142(45):2448-52.
Liver metastases occur in over 40% of patients with colorectal carcinomas. The best prospect of cure is achieved by resection of the metastases. However, only 10-15% of the patients with hepatic metastases are estimated to be candidates for resection. When curative resection cannot be performed the options for treatment are limited. Response rates to chemotherapy are around 40% and even then survival benefit is generally limited to a few months. Hepatic cryosurgery recently provided a new therapeutic approach for unresectable liver metastases. For cryosurgery tumour tissue is located by ultrasonography and then cooled by liquid nitrogen to a temperature of -196 degrees C, which results in necrosis of tumour tissue. In a limited number of series encouraging results of cryosurgery have been reported. One year and two year survival rates of respectively 70% and 50% were reported after cryosurgery for hepatic metastases. Disease free survival rate after 2 years varies from 20% to 28%. If recurrence of the disease occurred in the liver it was generally outside the areas treated by cryosurgery. Benefit in survival is only achieved when all tumour tissue is treated adequately. Hepatic cryosurgery is appropriate in those patients with unresectable metastatic disease in whom cryosurgery alone or in combination with resection is able to eradicate all metastatic disease in the liver.
超过40%的结直肠癌患者会发生肝转移。治愈的最大希望在于切除转移灶。然而，据估计，只有10% - 15%的肝转移患者适合进行切除手术。当无法进行根治性切除时，治疗选择就很有限。化疗的有效率约为40%，即便如此，生存获益通常也仅限于几个月。肝脏冷冻手术最近为无法切除的肝转移提供了一种新的治疗方法。对于冷冻手术，通过超声检查定位肿瘤组织，然后用液氮将其冷却至 - 196摄氏度，这会导致肿瘤组织坏死。在少数系列研究中，已报道了冷冻手术令人鼓舞的结果。肝转移冷冻手术后报告的1年和2年生存率分别为70%和50%。2年后的无病生存率在20%至28%之间。如果疾病在肝脏复发，通常发生在冷冻手术治疗区域之外。只有当所有肿瘤组织都得到充分治疗时，才能实现生存获益。肝脏冷冻手术适用于那些无法切除转移性疾病的患者，对于这些患者，单独冷冻手术或与切除手术联合能够根除肝脏中的所有转移性疾病。
