Vagvolgyi A, Takacs I, Arkossy P, Peter M, Sapy P
2nd Department of Surgery, University of Debrecen Medical and Health Science Center, School of Medicine, Debrecen, Hungary.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2176-8.
Liver resections for metastases of colorectal carcinomas are generally accepted. The 5-year survival rate is higher than 30 percent. Major resections can be performed safely with normal remnant liver. The liver regenerates following extended hepatectomies or other major resections. Authors operated on a 57-year-old man for a secondary liver tumor. The primary tumor was in the colon sigmoideum and sigma-resection was made at another hospital 16 months before. The metastasis was in the right lobe of the liver. Authors performed right extended hepatectomy. After systemic chemotherapy, 4.5 months later a new metastasis developed in the left lobe. Despite locoregional chemotherapy, chemoembolization and radiofrequency treatment, the tumor was still growing so a left lobectomy was performed. The patient is macroscopically tumor-free 17 months after the first hepatic resection. The interest in this case is that segments IV to VIII were removed first time, and segments II and III at the second liver resection. Liver regeneration after the first resection made the second operation possible. Only segment I of the original segments remained. Utilizing the regeneration of the liver we can make an effort to perform a complete tumor ablation in two steps.
结直肠癌肝转移的肝切除术已被广泛接受。5年生存率高于30%。对于正常肝残余组织，可安全地进行大手术切除。扩大肝切除或其他大手术后肝脏可再生。作者为一名57岁男性进行了继发性肝肿瘤手术。原发肿瘤位于乙状结肠，16个月前在另一家医院进行了乙状结肠切除术。转移瘤位于肝右叶。作者进行了右半肝扩大切除术。全身化疗4.5个月后，左叶出现新的转移瘤。尽管进行了局部化疗、化疗栓塞和射频治疗，肿瘤仍在生长，因此进行了左叶切除术。首次肝切除术后17个月，患者肉眼可见无肿瘤。该病例的意义在于首次切除了IV至VIII段，第二次肝切除时切除了II和III段。首次切除后的肝脏再生使第二次手术成为可能。原始肝段仅保留了I段。利用肝脏再生，我们可以努力分两步进行完整的肿瘤切除。
