早期结直肠癌淋巴结转移的危险因素分析及内镜切除指征的探讨  

Risk factors for lymph node metastasis of early colorectal cancer and indices of endoscopic resection

作　　者：德吉[1] 秦金玉[1] 王瑾[1] 朱林林[1] 杨锦林[1] 王一平[1] 吴俊超[1] 

机构地区：[1]四川大学华西医院消化内科,成都610041

出　　处：《中华消化内镜杂志》2015年第6期367-370,共4页Chinese Journal of Digestive Endoscopy

基　　金：四川省科技支撑计划（2013SZ0081）;四川省科技支撑计划（2014SZ0002-2）

摘　　要：目的探讨早期结直肠癌淋巴结转移的危险因素及可行内镜治疗的指征。方法2009年1月至2013年12月间，在四川大学华西医院行结直肠癌根治术治疗并经术后病理确诊的269例早期结直肠癌患者纳入回顾性分析，采用单因素和多因素分析方法寻找与淋巴结转移相关的危险因素，并归纳可行内镜治疗的指征。结果单因素分析显示肿瘤大小（P=0．029）、浸润深度（P：0．006）、分化程度（P=0．000）、淋巴管浸润（P=0．035）与早期结直肠癌淋巴结转移显著相关，多因素分析显示肿瘤大小（OR=5．385，95％CI：1．156～25．075，P=0．032）和分化程度（OR=5．145，95％CI：1．553—17．053，P=0．007）是影响早期结直肠癌淋巴结转移的独立危险因素。分析显示，浸润深度局限于黏膜内时未见淋巴结转移，发生淋巴结转移的情况仅见于肿瘤浸润至黏膜下层的患者中，且表现为肿瘤越大、分化程度越低的黏膜下层早期结直肠癌的淋巴结转移率越高（P〈0．05）。结论对于早期结直肠癌，浸润深度局限于黏膜内时未发生淋巴结转移，可行内镜切除术；当浸润至黏膜下层时，肿瘤越大、分化程度越低淋巴结转移概率越高，建议术前行超声内镜及活检以选择适合的手术方式。Objective To analyse the risk factors for lymph node metastasis of early colorectal cancer and the therapeutic indication for endoscopy. Methods The clinical data of the 269 early colorectal cancer patients who underwent surgical treatments between January 2009 and December 2013 in the West China hospital of Sichuan University were analyzed retrospectively. Pathologic features were compared between dif- ferent histological types and investigated by univariate and multivariate analysis of their possible risk factors for lymph node metastasis. Results Univariate analysis showed that tumor size （P = 0. 029）, depth of tumor invasion （ P = 0. 006 ）, histological type （ P = 0. 000 ） and lymphatic involvement （ P = 0. 035 ） were correla- ted with lymph node metastasis. Multivariate analysis revealed that tumor size （ OR = 5. 385,95% CI： 1. 156- 25. 075 ,P =0. 032） and histological type （ OR = 5. 145,95% CI： 1. 553-17. 053 ,P = 0. 007 ） were independ- ent risk factors for lymph node metastasis. Comprehensive analysis showed that lymph node metastasis could not be found in patients with tumor invading the mucous layer. However,lymph node metastasis occurred if the tumor invaded the submucous layer. The larger and less differentiated tumor was, the higher occurrence of lymph node matastasis would be （P 〈 0.05 ）. Conclusion Endoscopic resection is recommended for those with early colorectal cancer localized in the mucous layer and without lymph node metastasis. It is recommended that patients with submucosal carcinomas undergo a preoperative endoscopic uhrasonography or pathological screening for the most appropriate surgical treatment, as the larger and the lower differentiated the tumor is, the higher chance the lymphatic metastasis is.

关 键 词：早期结直肠癌 淋巴结转移 内镜下治疗 外科手术 

分 类 号：R735.34[医药卫生—肿瘤]