梗阻性结直肠癌临床病理特征及预后分析  

Clinicopathological features and prognosis analysis of the obstructive colorectai cancer

作　　者：吴鸿伟[1] 邓薇[1] 姚宏伟[1] 赵晓牧[1] 杨盈赤[1] 吴国聪[1] 张忠涛[1] 王今[1] 金岚[1] Wu Hongwei;Deng Wei;Yao Hongwei;Zhao Xiaomu;Yang Yingchi;Wu Cuocong;Zhang Zhongtao;Wang Jin;din Lan.(Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, National Center for Clinical Medicine of Digestive System Diseases, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科 国家消化系统疾病临床医学研究中心,100050

出　　处：《中华消化外科杂志》2018年第2期148-153,共6页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划（2015BAI13B09）;北京市医院管理局临床医学发展专项（ZYLX201504）

摘　　要：目的：探讨梗阻性结直肠癌的临床病理特征及预后情况。方法：采用回顾性横断面研究方法。收集2013年1月至2015年12月首都医科大学附属北京友谊医院收治的667例结直肠癌患者的临床病理资料。结直肠癌患者的诊断与治疗以美国国立综合癌症网络（NCCN）结直肠癌实践指南2013版及美国癌症联合会（AJCC）肿瘤分期第7版为基础。由肠镜、活组织病理学、CT和（或）MRI检查确诊结直肠癌及其临床分期。符合适应证的直肠癌患者进行术前辅助治疗。根据患者病情选择腹腔镜手术或开腹手术。观察指标：（1）诊断及治疗情况。（2）临床病理学特征。（3）预后情况。采用门诊和电话方式进行随访，随访内容为术后患者总体生存和无瘤生存情况。随访时间截至2017年4月。正态分布的计量资料以±s表示，组间比较采用t检验。计数资料以例数、百分数表示，组间比较采用X2检验及Fisher确切概率法检验。等级资料采用非参数检验。结果：（1）诊断及治疗情况：667例结直肠癌患者肿瘤位置：右半结肠213例、左半结肠312例、直肠142例；术前临床分期：0期3例、Ⅰ期47例、Ⅱ期300例、Ⅲ期298例、Ⅳ期 19例；99例发生肠梗阻（梗阻性结直肠癌），568例未发生肠梗阻（非梗阻性结直肠癌），结直肠癌肠梗阻发生率为14.84%（99/667）。667例患者的治疗情况：①术前辅助治疗：17例非梗阻性结直肠癌行术前辅助治疗，650例未行术前辅助治疗；②手术治疗：389例行开腹手术、278例行腹腔镜手术；588例行根治性切除术、79例行非根治性切除术。（2）临床病理学特征：99例梗阻性结直肠癌患者，肿瘤位置位于右半结肠、左半结肠、直肠分别为26、61、12例，手术方式腹腔镜手术、开腹手术分别为18、81例，根治性切除为71例，肿瘤分化程度低分化、中分化、高分化分别为21、61�Objective：To explore the clinicopathological features and prognosis of the obstructive colorectal cancer （CRC）. Methods：The retrospective crosssectional study was conducted. The clinicopathological data of 667 CRC patients who were admitted to the Beijing Friendship Hospital Affiliated to Capital Medical University between January 2013 and December 2015 were collected. The diagnosis and treatment of CRC patients were based on colon cancer and rectal cancer clinical practice guidelines in oncology （Version 2013） of the National Comprehensive Cancer Network （NCCN） and the 7th edition of the American Joint Committee on Cancer （AJCC） cancer staging manual and the future of TNM. CRC and clinical staging were confirmed by colonoscopy, biopsy pathology and CT or MRI examination. Patients selected laparoscopic surgery or open surgery according to their conditions, and then selectively underwent postoperative adjuvant therapy based on the results of pathological examination. Observation indicators： （1） diagnosis and treatment; （2） clinicopathological features; （3） prognosis. Followup using outpatient examination and telephone interview was performed to detect postoperative overall and tumorfree survivals up to April, 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Count data were described as case and percentage, comparisons between groups were evaluated with the chisquare test. Ordinal data were analyzed using the nonparametric test. Results：（1） Diagnosis and treatment： tumor locations of 677 patients： tumors located in the right hemicolon, left hemicolon and rectum were respectively detected in 213, 312 and 142 patients. Preoperative clinical staging： 3, 47, 300, 298 and 19 patients were respectively detected in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ. Ninetynine patients were complicated with intestinal obstruction, with an obstructive rate of 14.84% （99/667）, and 568 patients didn′t have inte

关 键 词：结肠肿瘤 直肠肿瘤 肠梗阻 诊断 治疗 预后 

分 类 号：R735.34[医药卫生—肿瘤]