腹腔镜直肠癌根治术后患者的长期生存及其影响因素  

An analysis of long-term survival after laparoscopic radical resection for rectal cancer

作　　者：曾焕虹 傅卫[1] 孙涛[1] 王重凯[1] 王冰炎 张利[1] 袁炯[1] 王德臣[1] 修典荣[1] 

机构地区：[1]北京大学第三医院普通外科,100191

出　　处：《中华普通外科杂志》2018年第1期25-29,共5页Chinese Journal of General Surgery

基　　金：国家临床重点专科建设基金资助项目

摘　　要：目的探讨腹腔镜直肠癌根治术后患者的生存情况及其预后影响因素。方法回顾性分析2007年1月至2010年12月间北京大学第三医院收治的腹腔镜直肠癌根治术235例患者的临床病理资料，用COX比例风险回归模型确定影响患者的总生存期和无病生存期的危险因素。结果235例腹腔镜直肠癌根治术后患者3年、5年的局部复发率分别为8．1％、9．8％，3年、5年总生存率分别为85．2％、77．1％，3年、5年无病生存率分别为75．1％、69．6％。腹腔镜Hamann术、术后发生并发症、TNM分期为Ⅲ期、神经侵犯、溃疡型肿瘤为患者总生存期的不良预后因素，腹腔镜HaAmann术、术后发生并发症、TNM分期为Ⅲ期、溃疡型肿瘤为患者无病生存期的不良预后因素。结论腹腔镜Hartmann术、术后发生并发症、TNM分期为Ⅲ期、溃疡型肿瘤为总生存期和无病生存期共同的不良预后因素。总生存期的不良预后因素还包括神经侵犯。Objective To evaluate the efficacy of laparoscopic l^dical resection for rectal cancer by collecting and analyzing long-term outcomes of patients and to investigate prognostic factors of overall survival and disease free survival. Methods The clinicopathologieal data of 235 patients who underwent laparoseopic radical resection for rectal cancer from Jan 2007 to Dec 2010 were retrospectively analyzed. COX proportional hazards regression model was used to determine the risk factors for overall survival and disease free survival. Results A total of 235 patients were included in this analysis. Local recurrence rate were 8.1% at 3 years and 9.8% at 5 years. Overall and disease free survival were 85.2% and 75.1% at 3 years, 77. 1% and 69. 6% at 5 years, respectively. Factors found to significantly and independently predict a poor overall and disease free survival were laparoscopic Hartmann, postoperative complications, stage m tumor and ulcerative type tumor. Neural invasion was also an adverse prognostic factor of overall survival. Conclusions Laparoscopic Hartmann, postoperative complications, stage m tumor and ulcerative type tumor were independently associated with overall and disease free survival. In addition to this, neural invasion was also an adverse prognostic factor of overall survival.

关 键 词：直肠肿瘤 存活率分析 腹腔镜 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]