影响低位直肠癌手术保肛相关因素的研究  

Study on influencing factors of sphincter preserving operation in lower rectal cancer

作　　者：朱乃标[1] 董米连[1] 章园[1] 张锐利[1] 林祖朝[1] 王宝枝[1] 

机构地区：[1]温州医学院附属台州医院普外科,317000

出　　处：《浙江临床医学》2008年第12期1551-1553,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析影响低位直肠癌手术保肛的相关因素。方法将341例低位直肠癌患者按是否施行保肛手术而分为APR组和SP组,对两组病例临床资料(包括肿瘤下缘距肛缘的距离、患者年龄、性别、BMI)及病理资料(包括肿瘤周径、肿瘤位置、肿瘤大体分型、分化程度和Dukes分期)进行比较分析。结果APR组肿瘤下缘距肛缘距离显著小于SP组,肿瘤周径小于1/2周、1/2～3/4周、大于3/4周及全周四者保肛率依次下降(P<0.01),对于肿瘤周径小于1/2周者,肿瘤主体位于后壁、侧壁及前壁者三者保肛率依次下降,但无明显统计学意义(P>0.05)。肿瘤大体分型中,肿块型、溃疡型及浸润型三者保肛率依次下降(P<0.05),肿瘤病理呈高、中、低分化癌者三者保肛率逐渐下降(P<0.01),低位直肠癌DukesA、B、C、D期四者保肛率呈逐渐下降趋势。青年人、男性、BMI≥23的患者其保肛率显著低于中老年人、女性及BMI<23的患者(P<0.05)。结论肿瘤下缘距齿状线或肛缘的距离是低位直肠癌手术保肛最主要的影响因素,肿瘤周径、肿瘤病理分期、肿瘤主体位置、肿瘤大体分型、肿瘤分化程度及患者的性别及BMI等均可对低位直肠癌手术保肛产生影响。Objective To analyze the influencing factors of sphincter preserving operation in lower rectal cancer. Methods 341 patients with lower rectal cancer were divided into two groups according to the methods of operations： the abdominoperineal resection （APR） group and the sphincter preserving （SP） group. The clinical and pathological data （including： distance of tumor lower margin from anal edge , age, gender, Body Mass Index, circumference of intramural spread, tumor location, tumor macropathological type, degree of differentiation and Dukes stage）between the two groups were compared. Results The distance of tumor lower margin from anal edge in APR group was shorter than in that in SP group. The SP rates in patients with circumference of intramural spread 〈 1/2 circle, 1/2 - 3/4circle, 〈 3/4circle and whole circle were gradually decreased （ P 〈 0.01 ） ; Among the patients with tumor circumference of intramural spread 〈 1/2 circle, the SP rates in patients with tumor located in the posterior, anterior and lateral were also gradually decreased, but the difference had no statistic significance（ P 〉 0.05）. Significant different SP rates were detected in different tumor macropathological types （nedus type, ulcer type, infiltrating type.）, and they were were gradually decreased （P 〈 0.05）, and the same difference was found in high, medium, and poorly differentiated cancers. The SP rates in patients with cancer Dukes＇ staging A, B, C, and D were gradually decreased. Conclusions The most important influencing factors of sphincter preserving operation in lower rectal cancer is the distance of tumor lower margin from anal edge or the pectinate line. However, the influencing factors of sphincter preserving operation in lower rectal cancer also included other factors, such as circumference of intramural spread , Dukes staging, tumor＇s location, tumor＇s macropathological type, tumor＇s differentiation, and patients＇ age, gender and body mass index.

关 键 词：低位 直肠癌 保肛手术 影响因素 

分 类 号：R735.37[医药卫生—肿瘤] R735.34[医药卫生—临床医学]