直肠肛管癌选择经括约肌间切除术的多因素分析  

Multivariate Analysis of Factors Affecting Choice of Intersphincteric Resection in Anorectal Cancer

作　　者：欧阳书睿[1,2] 陈华[1,2] 邓磊[1,2] 吕东昊[1,2] 陈小龙[1,2] 肖凌[1,3] 曾天芳[1,2] 汪晓东[1,4] 李立[1,4] 

机构地区：[1]四川大学华西医院胃肠外科中心MCQ团队,成都610041 [2]四川大学华西临床医学院 [3]四川大学华西口腔医学院 [4]四川大学华西医院胃肠外科中心

出　　处：《肿瘤防治研究》2011年第7期803-805,813,共4页Cancer Research on Prevention and Treatment

基　　金：四川省卫生厅科研课题资助项目(080278)

摘　　要：目的探讨影响超低位直肠/直肠肛管癌经括约肌间切除术(Intersphincteric resection,ISR)选择的临床病理因素。方法回顾性分析由同一组专业医师共同完成的超低位直肠癌(肿瘤距肛缘≤5cm或距齿状线≤3cm)切除术患者156例。纳入指标包括:年龄、性别、肿瘤分化程度、肿瘤距肛缘距离、病理TNM分期、术前CS分期和新辅助治疗。结果共有63例患者接受ISR,93例患者未接受此术式。单因素分析表明肿瘤病理T分期(P=0.038)、N分期(P=0.044)和术前CS分期(P<0.001)与ISR选择有关。多因素分期显示肿瘤病理T分期、N分期和CS分期是影响直肠肛管癌ISR选择的独立因素。结论超低位直肠癌患者是否可行经括约肌间切除术与肿瘤局部浸润程度、淋巴结受累情况有关,而与肿瘤距肛缘距离、肿瘤分化程度及新辅助化疗无关。直肠指检仍是决定是否可行经括约肌间切除术的有效方法。Objective The purpose of this study was to identify clinicopathological factors affecting the choice of intersphincteric resection（ISR）.Methods This retrospective study analyzed records of 156 consecutive patients with anorectal cancer（≤5 cm above the anal verge or ≤3 cm above the dentate line） from January 2006 to June 2008.Patients were operated by the same group of surgeons.Variables analyzed included age,sex,differentiation,tumor distance to anal verge,pathological T,N,TNM and clinical stages（staging based on digital rectal examination） and neo-adjuvant therapy.Results The number of patients who underwent ISR or not were 63 and 93,respectively.In the univariate analysis,significant factors were pathological T（P=0.038）,N（P=0.044） and clinical（P0.001） stages.The multivariate analysis showed that pathological T（P=0.027）,N（P=0.016） and clinical（P0.001） stages were independently associated with the choice of ISR.Conclusion When faced with a patient with anorectal cancer,the decision to perform ISR is determined by local infiltration and involvement of lymph nodes,regardless of tumor distance,differentiation or neoadjuvant therapy.Digital rectal examination remains a useful method in ISR decision-making.

关 键 词：超低位直肠癌 直肠肛管癌 经括约肌间切除术 

分 类 号：R735.3[医药卫生—肿瘤]