腹腔镜直肠癌根治术后异时性肝转移的危险因素及预后分析  

Analysis of risk factors and prognosis of metachronous liver metastasis after laparoscopic radical resection of rectal cancer

作　　者：但杰[1] 王健[1] 王永洪[1] 朱明杰[1] 彭忠[1] 蒋鸿元 陈雷[1] DAN Jie;WANG Jian;WANG Yong-hong;ZHU Ming-jie;PENG Zhong;JIANG Hong-yuan;CHEN Lei(Department of Gastrointestinal Surgery,Leshan People s Hospital,Leshan 614000,China)

机构地区：[1]四川省乐山市人民医院胃肠外科,四川乐山614000

出　　处：《实用医院临床杂志》2018年第2期148-150,共3页Practical Journal of Clinical Medicine

摘　　要：目的分析腹腔镜直肠癌根治术后发生异时性肝转移的危险因素,探讨影响肝转移患者预后的因素。方法分析2010~2016年我院327例行腹腔镜直肠癌根治术患者的临床资料、预后情况等资料,采用单因素和Cox比例风险回归模型等分析影响腹腔镜直肠癌根治术后异时性肝转移的危险因素及生存的相关因素。结果 327例患者中位随访时间为31个月(7~46个月)。TNM分期Ⅰ期32例,Ⅱ期98例,Ⅲ期197例。手术后半年以上共发生81例(24.7%)异时性肝转移。患者术后随访至诊断为肝转移的中位时间为16个月。肝转移的患者生存时间为(18±7)个月,3年累积生存率为22.6%;未发生肝转移的患者生存时间为(36±8)个月,3年累积生存率为75.3%;两者的生存情况比较,差异有统计学意义(χ~2=18.314,P<0.05)。多因素分析结果显示:淋巴结转移是影响腹腔镜直肠癌根治术后异时性肝转移的独立危险因素(OR=3.271,P<0.05)。术前CEA水平>5μg/L和是否切除肝转移瘤是影响肝转移患者预后不良的独立危险因素(P<0.05)。结论腹腔镜直肠癌根治术后是否发生肝脏转移是影响患者生存的重要因素,淋巴结转移是发生术后异时性肝转移的高危因素,术前CEA异常升高和是否再次手术切除肝转移病灶是影响异时性肝转移患者预后的独立相关因素。To analyze the risk factors of metachronous liver metastasis after radical resection of laparoscopic rectal cancer,and to explore the factors influencing the prognosis of the patients.The clinical data and prognosis of 327 patients undergoing laparoscopic radical resection of rectal cancer during the period between 2010 and 2016 were analyzed.Single factor and Cox proportional hazards regression model were used to analyze the risk factors of metastasis and the related factors of survival after the operation.The median follow-up time was 31 months(7 to 46 months)for the 327 patients.There were 32 patients with TNM stage I,98 with stage II and 197 with stage III.There were 81 patients(24.7%)with metachronous liver metastasis after more than half a year of the operation.The median time from follow-up to diagnose of liver metastases was 16 months.The survival time of patients with liver metastases was(18±7)months,and the cumulative survival rate was 22.6%during 3 years.The survival time of patients without liver metastasis was(36±8)months and the cumulative survival rate was 75.3%.The difference was statistically significant(χ2=18.314,P<0.05).Multivariate analysis showed that lymph node metastasis was an independent risk factor for the metachronous liver metastasis(OR=3.271,P<0.05).CEA level,lymph node metastasis and resection of liver metastases were the influencing factors for prognosis(P<0.05).Multivariate analysis showed that preoperative CEA level>5μg/L and no resection of liver metastases were independent risk factors for poor prognosis in patients with liver metastases(P<0.05).The occurrence of liver metastasis is an important factor affecting the survival of patients after laparoscopic radical surgery of rectal cancer.Lymph node metastasis is a high risk factor for the occurrence of postoperative metachronous liver metastasis.Preoperative CEA abnormalities and the resection of liver metastases are the independent prognostic factors of patients with heterogeneous liver metastasis.

关 键 词：直肠癌 肝转移 异时性 

分 类 号：R735.37[医药卫生—肿瘤]