低位直肠癌经腹会阴联合切除术与前切除术后临床疗效的比较研究  

Comparative study of clinical efficacy between abdominoperineal resection and anterior resection procedure in patients with rectal cancer

作　　者：申占龙[1] 叶颖江[1] 张鑫[1] 谢启伟[1] 尹慕军[1] 杨晓东[1] 姜可伟[1] 梁斌[1] 王杉[1] 

机构地区：[1]北京大学人民医院胃肠外科,100044

出　　处：《中华胃肠外科杂志》2015年第4期349-353,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81372290）

摘　　要：目的：比较低位直肠癌经腹会阴联合切除术（APR）和前切除术（AR）后的临床疗效。方法回顾性分析北京大学人民医院1998年1月至2010年12月间接受APR（151例，APR组）和AR（158例，AR组）术式的低位直肠癌患者的临床资料，比较两组短期结局指标、局部复发率、总生存率及无进展生存率。结果 APR组较AR组患者的手术时间长[（268．5±66．7） min比（247．4±64．2） min，P＝0．005]，术中出血量[（668．5±680．1） ml比（441．8±478．6） ml，P＝0．001]和术后引流量多[（66．9±54．7） ml比（49．0±45．9） ml，P＝0．002]。两组患者局部复发率的差异无统计学意义（ P＝0．188），但对于T3～T4期患者，APR组患者的5年局部复发率（24．9％）明显高于AR组（13．9％）（P＝0．038）。肿瘤下缘距肛门4～6 cm的T3～T4期APR组患者的5年局部复发率（27．5％）明显高于AR组（13．0％）（P＝0．038）。两组的总生存率和无进展生存率的差异均无统计学意义（均P＞0．05）；但当体质量指数大于或等于24 kg／m2时，APR组T3～T4期患者的5年总生存率（43．1％）和无进展生存率（42．8％）均明显低于AR组（87．9％和76．9％，P＝0．022和P＝0．041）。结论低位直肠癌APR和AR术后患者总体预后相当，但当患者肿瘤位于距肛缘4～6 cm、T3～T4分期和肥胖时，APR术后患者总体预后较差。Objective To compare clinical efficacy between abdominoperineal resection （APR） procedure and anterior resection （AR） procedure in patients with rectal cancer. Methods Clinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People′s Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival （OS） and progression-free survival （PFS） were investigated between two groups. Results As compared to the AR group, the operative time was longer [（268.5± 66.7） min vs. （247.4±64.2） min, P=0.005], blood loss[（668.5±680.1） ml vs.（441.8±478.6） ml, P=0.001] and drainage volume were more [（66.9±54.7） ml vs. （49.0±45.9） ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3~T4 patients undergoing APR procedure （24.9%） was higher than that of AR group （13.9%）（P=0.038）, especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS （P=0.273） and PFS （P=0.589） between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI≥24 undergoing APR procedure （43.1% and 42.8%） were significantly worse than those of patients undergoing AR procedure （87.9% and 76.9%, P=0.022 and P=0.041）. Conclusions The overall prognosis of patients after APR and AR iscomparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.

关 键 词：直肠肿瘤 直肠前切除术 经腹会阴联合切除术 复发 生存 

分 类 号：R735.37[医药卫生—肿瘤]