TNM分期对直肠/肛管癌患者结肛吻合术后近期疗效的影响  

Influence of TNM staging on short-term effect of coloanal anastomosis patients with rectal/anal cancer

作　　者：甘志明 马琛 李立[2] 陈凤姣 刘畅[1] 汪晓东[2] 

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

出　　处：《西部医学》2012年第9期1705-1708,共4页Medical Journal of West China

摘　　要：目的探讨TNM分期是否会影响直肠/肛管癌患者行结肛吻合术后近期疗效。方法回顾性分析118例接受结肛吻合术并符合本研究条件的直肠/肛管癌患者的临床资料,根据患者的TNM分期分组,将Ⅰ期患者定为A组(18例),Ⅱ期患者定为B组(40例),Ⅲ期患者定为C组(37例),Ⅳ期患者定为D组(23例),比较4组的手术安全性和术后恢复指标。结果 4组排便时间及排气时间差异有统计学意义(P为0.032、0.040);进一步两两比较,D组患者排便时间略晚于A、B、C 3组,差异有统计学意义(P为0.019、0.037和0.040),而A、B、C组间差异无统计学意义(A、B两组P为0.851,A、C两组P为0.765,B、C两组P为0.536);D组患者排气时间略晚于A、B、C 3组,差异有统计学意义(P为0.029、0.033、0.036),而A、B、C组间差异无统计学意义(A、B两组P为0.841,A、C两组P为0.765,B、C两组P为0.736)。术后4组间并发症发生率差异无统计学意义。结论 TNM分期对IV期直肠/肛管癌患者结肛吻合术后近期疗效有一定影响,可延长其首次排气及排便时间,但并未提高患者的并发症发生率,仍能取得较好的保肛效果。而Ⅱ～Ⅲ期直肠/肛管癌患者与Ⅰ期患者相比结肛吻合术后无论在术后恢复情况,还是并发症发生率方面均未见不同。因此,就近期疗效而言,Ⅱ～Ⅲ期直肠/肛管癌患者行结肛吻合术是较安全可行的,TNM分期并不影响术后的近期疗效。Objective To explore the effect of TNM staging on the short-term quality of coloanal anastomosis for the patients with rectal/anal cancer.Methods The identified patients were diagnosed as rectal/anal cancer.We divided patients into four groups according to TNM staging,and the patients with TNM staging I were defined as A group,the patients with TNM staging Ⅱ were defined as B group,the patients with TNM staging Ⅲ were defined as C group,the patients with TNM staging IV were defined as D group.Results Sex,age,and stage and location of tumor of the groups were not different from each other.When taking First defecation time and First aerofluxus time into consideration,the difference of four groups were significant（P=0.032,0.040）,and the First defecation time of D group is significantly more than A group,B group and C group（P=0.019,0.037,0.040）,but the difference among A group,B group and C group in first defecation time were not significant,the first aerofluxus time of D group was significantly more than A group,B group and C group（P=0.029,0.033,0.036）,but the difference among A group,B group and C group in first defecation time are not significant.When taking the incidence rate of complications into consideration,the difference between four groups is not significant（P=0.127）.Conclusion Although TNM staging can affect the short-term quality of coloanal anastomosis for the patients whose TNM staging is Ⅳ,but not raise the incidence rate of complications,so we think coloanal anastomosis for the patients whose TNM staging is Ⅳ still can achieve satisfying short-term quality.In terms of the patients whose TNM staging is Ⅱ-Ⅲ,the difference of the observe index between A group and B group are not significant,so coloanal anastomosis for the patients whose TNM staging is Ⅱ-Ⅲ can achieve good short-term quality,is safe and effective.

关 键 词：TNM分期 直肠/肛管癌 结肛吻合术 疗效 

分 类 号：R735[医药卫生—肿瘤]