Coppa G F
New York University School of Medicine, New York.
Bull N Y Acad Med. 1990 May-Jun;66(3):211-20.
Hepatic resection of metastatic disease due to primary colorectal cancer provides a relatively safe and reliable method to control this otherwise fatal disease. At New York University 45 hepatic resections have been performed in 42 patients over the last fifteen years. Preoperative screening was performed by liver chemistry and intraoperative exploration in synchronous lesions and by liver chemistry, carcinoembryonic antigen, and computed tomography in metachronous lesions. Careful monitoring of fluid management, glucose utilization, and albumin requirements are essential for low postoperative morbidity and mortality. In major hepatic resections, changes in coagulation profile correlate with normalization of hepatic function as evidenced by decrease in serum bilirubin levels and increase bile production. The incidence of major operative morbidity was 17%; operative mortality was 4%. Hepatic resection gives the greatest possibility of extended survival, in our patients providing a 22% crude five year survival rate and a mean duration of survival of 33 months.
对原发性结直肠癌所致的转移性疾病进行肝切除，为控制这种原本致命的疾病提供了一种相对安全可靠的方法。在过去15年里，纽约大学对42例患者实施了45次肝切除术。术前筛查对于同时性病变通过肝功能检查和术中探查进行，对于异时性病变则通过肝功能检查、癌胚抗原和计算机断层扫描进行。密切监测液体管理、葡萄糖利用和白蛋白需求对于降低术后发病率和死亡率至关重要。在主要肝切除术中，凝血指标的变化与肝功能的恢复正常相关，血清胆红素水平降低和胆汁分泌增加证明了这一点。主要手术并发症的发生率为17%；手术死亡率为4%。肝切除为延长生存期提供了最大可能性，在我们的患者中，粗五年生存率为22%，平均生存期为33个月。
