Weaver M L, Atkinson D, Zemel R
Department of Surgery, Allegheny General Hospital Pittsburgh, Pennsylvania, USA.
Cancer. 1995 Jul 15;76(2):210-4. doi: 10.1002/1097-0142(19950715)76:2<210::aid-cncr2820760208>3.0.co;2-s.
The purpose of this study was to determine the effectiveness of cryosurgery as an adjunct to resection in treating patients with hepatic metastases from colorectal adenocarcinoma.
Forty-seven patients with documented metastases limited to the liver from colorectal adenocarcinoma were treated with cryosurgery with or without resection from November 1987 to February 1992 and were followed until February 1994. Intraoperative ultrasound was used to map the lesions and place the cryoprobes. Each lesion was frozen to -196 degrees centigrade for 15 minutes, thawed for 10 minutes, and frozen again for 15 minutes. Follow-up computed tomographic scans were obtained before hospital discharge and 6 months and 1 year after cryosurgery. Carcinoembryonic antigen levels were obtained monthly.
Thirty-one males and 16 females, with a median age of 63 years, were treated. The median hospital stay was 10 days, and follow-up ranged from 24 to 57 months, with a median follow-up of 26 months. The actual survival at 24 months was 62%. Eleven percent of these patients had no evidence of disease at a median follow-up of 30 months. Complications included myoglobinuria, coagulopathy, pleural effusions, and bile duct injuries. Two patients (4%) died because of multisystem organ failure with irreversible coagulopathies.
Cryosurgical ablation increases the number of patients with liver metastases who potentially can become disease free. However, the effect on overall survival will require a longer follow-up period.
本研究的目的是确定冷冻手术作为结直肠癌肝转移患者切除术辅助手段的有效性。
1987年11月至1992年2月，对47例经证实为结直肠癌肝转移且转移灶局限于肝脏的患者进行了冷冻手术，部分患者同时进行了切除术，并随访至1994年2月。术中超声用于描绘病灶并放置冷冻探头。每个病灶先冷冻至零下196摄氏度，持续15分钟，解冻10分钟，然后再次冷冻15分钟。出院前、冷冻手术后6个月和1年进行随访计算机断层扫描。每月检测癌胚抗原水平。
共治疗31例男性和16例女性患者，中位年龄63岁。中位住院时间为10天，随访时间为24至57个月，中位随访时间为26个月。24个月时的实际生存率为62%。其中11%的患者在中位随访30个月时无疾病证据。并发症包括肌红蛋白尿、凝血功能障碍、胸腔积液和胆管损伤。两名患者（4%）因多系统器官衰竭伴不可逆凝血功能障碍死亡。
冷冻消融术增加了肝转移患者可能实现无病状态的人数。然而，对总生存期的影响还需要更长的随访期。
