Эффективность циторедуктивных расширенных резекций первичной опухоли при колоректальном раке IV стадии тема диссертации и автореферата по ВАК РФ 14.01.17, кандидат медицинских наук Миракян, Степан Сейранович

• Миракян, Степан Сейранович
• кандидат медицинских наук
• 2012

Оглавление диссертации кандидат медицинских наук Миракян, Степан Сейранович

Введение

1 ОБЗОР ЛИТЕРАТУРЫ

1.1 Современное состояние проблемы.

1.2 Место химиотерапии в лечении метастатического колоректального рака.

1.3 Тактика в отношении первичной опухоли

1.4 Стратегия лечения метастатического рака

1.5 Лечение синхронного метастатического поражения

2 МАТЕРИАЛЫ И МЕТОДЫ

2.1 Общие понятия, классификации

2.2 Методы отбора больных для включения в исследование, дизайн исследования, методы сбора данных

2.3 Порядок обследования пациентов перед операцией

2.4 Система мониторинга больных в послеоперационном периоде

2.5 Методы оценки характера метастатического поражения

2.6 Алгоритм лечения синхронного метастатического колоректального рака

2.7 Методы морфологического исследования

2.8 Статистический анализ материала

2.9 Клиническая характеристика больных, включенных в исследование

3 ТЕХНИКА ХИРУРГИЧЕСКОГО ВМЕШАТЕЛЬСТВА ПРИ РАКЕ ТОЛСТОЙ КИТ! 1КИ.

3.1 Общие принципы удаления опухолей ободочной кишки.

3.2 Выделение кишки и удаление первичной опухоли

3.3 Активизация больных в послеоперационном периоде.

4 РЕЗУЛЬТАТЫ МОРФОЛОГИЧЕСКОГО ИССЛЕДОВАНИЯ УДАЛЕННЫХ ПРЕПАРАТОВ ПОСЛЕ РАСШИРЕННЫХ РЕЗЕКЦИЙ ТОЛСТОЙ КИШКИ ПРИ РАКЕ 1УСТАДИИ.

5 НЕПОСРЕДСТВЕННЫЕ РЕЗУЛЬТАТЫ РАСШИРЕННЫХ ОПЕРАЦИЙ ПРИ МЕТАСТАТИЧЕСКОМ КОЛОРЕКТАЛЬНОМ РАКЕ.

5.1 Интраоперационные результаты

5.2 Оценка раннего послеоперационного периода

6 ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ОПЕРАЦИИ С РАСШИРЕННОЙ ЛИМФАДЕНЭКТОМИЕЙ ПРИ СИНХРОННОМ МЕТАСТАТИЧЕСКОМ КОЛОРЕКТАЛЬНОМ РАКЕ.

Заключение диссертации по теме «Хирургия», Миракян, Степан Сейранович

Выводы

1. Скелетизация сосудов и нервосохраняющая хирургия при выполнении расширенной лимфодиссекции, мезоколон- и мезоректумэктомия проводимые с применением современных устройств для диссекции и коагуляции тканей, позволяют выполнять расширенные циторедуктивные вмешательства на первичной опухоли с соблюдением всех принципов онкологического радикализма даже при IV стадии рака толстой кишки.

2. Высокая частота поражения лимфатических узлов (65%) в том числе второго и третьего порядка (28% и 11% соответственно) при метастатическом КРР свидетельствуют о необходимости включения расширенной лимфодиссекции в протоколы лечения первичной опухоли.

3. Выполнение экстенсивных вмешательств на первичной опухоли с расширенной лимфаденэктомией сопровождается невысоким уровнем послеоперационных осложнений (12,6%) и летальности (2,6%), что сопоставимо с аналогичными результатами лечения неметастатического колоректального рака.

4. Резекционные вмешательства на первичной опухоли с расширенной лимфаденэктомией при синхронном метастатическом колоректалыюм раке позволяют добиться 35% кумулятивной трехлетней выживаемости при частоте местной прогрессии заболевания 4,4 %.

5. Факторами, негативно влияющими на отдаленные онкологические результаты, являются мультифокальный и мультиорганный характер метастатического поражения, локализация опухоли в прямой и правой половине ободочной кишки, а также отсутствие возможности проведения химиотерапии и вмешательств по поводу отдаленных проявлений болезни.

6. Оптимальным протоколом лечения метастатического колоректального рака является резекция первичной опухоли с максимально полным удалением зон регионарного лимфооттока (по возможности комбинированная с хирургическим воздействием на метастазы), химиотерапия, при условии резектабельности -хирургия метастатического поражения.

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