中国结直肠癌同时性腹膜转移外科诊治现状分析:16家中心1 003例报告  

The status analysis of diagnosis and treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China:a report of 1 003 cases in 16 domestic medical centers

作　　者：王怀明[1] 王贵玉[2] 黄颖[3] 任黎[4] 张宏[5] 武爱文[6] 韩加刚[7] 舒晓刚[8] 王贵英[9] 杨盈赤[10] 王自强[11] 崔明[6] 卢云[12] 冯波[13] 周建平[14] 吴斌[15] 童卫东 王辉[1] 骆衍新[1] 吴小剑[1] 蔡建 姚宏伟[10] 王磊[1] Wang Huaiming;Wang Guiyu;Huang Ying;Ren Li;Zhang Hong;Wiu Aiven;Han Jiagang;Sha Xiogang;Wang Guiying;Yang Yingchi;Wang Ziqiang;Cui Ming;Lu Yun;Feng Bo;Zhou Jiamping;WU Bin;Tong Weidong;Wang Hui;Luo Yanxin;Wu Xiaoian;Cai Jian;Yao Hongwei;Wang Lei(Department of Colorectal Surgery,the Sixth Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510655,China;Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Gastrointestinal Surgery,Huangdao Branch,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastrointestinal Surgery,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Gastrointestinal Surgery,the First Hospital of China Medical University,Shenyang 110001,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Gastric & Colorectal Division,Department of General Surgery,Daping Hospital,Army Medical University,Chongqing 400042,China;Department of Colorectal Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Colon and Rectum Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Colorectal Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Colorectal Cancer Surgery,Shengjing Hospital of China Medical University,Shenyang 110000,China;Department of Gastrointestinal Surgery,Peking University Cancer Hospital,Beijing 100142,China;Department of General Surgery,Beijing Chaoyang Hosptial,Capital Medical University,Beijing 100020,China;Department of Gastrointestinal Minimal Invasive Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of General Surgery,Fourth Hospital of Hebei Medical Un

机构地区：[1]中山大学附属第六医院结直肠肛门外科,广州510655 [10]首都医科大学附属北京友谊医院普外科,100050 [11]四川大学华西医院胃肠外科,成都610041 [12]青岛大学附属医院黄岛院区胃肠外科,266000 [13]上海交通大学医学院附属瑞金医院胃肠外科,200025 [14]中国医科大学附属第一医院胃肠外科,沈阳110001 [15]中国医学科学院北京协和医学院北京协和医院基本外科,100730 [16]陆军军医大学大坪医院普通外科胃结直肠病区,重庆400042 [2]哈尔滨医科大学附属第二医院结直肠肿瘤外科,150086 [3]福建医科大学附属协和医院结直肠外科,福州350001 [4]复旦大学附属中山医院结直肠外科,上海200032 [5]中国医科大学附属盛京医院结直肠肿瘤外科,沈阳110000 [6]北京大学肿瘤医院胃肠肿瘤中心,100142 [7]首都医科大学附属北京朝阳医院普外科,100020 [8]华中科技大学同济医学院附属协和医院胃肠微创外科,武汉430022 [9]河北医科大学第四医院外二科,石家庄050000

出　　处：《中华外科杂志》2019年第9期666-672,共7页Chinese Journal of Surgery

摘　　要：目的了解我国结直肠癌同时性腹膜转移外科治疗的现状。方法回顾性收集国内16家医疗中心2003年10月至2018年10月收治的经手术证实为同时性腹膜转移的结直肠癌患者的临床病理学资料,利用Excel建立数据库,资料包括基线资料、实验室检查、影像学检查、放化疗情况、术中情况、术后病理学结果、随访数据,共7个部分77个字段。采用Wilcoxon秩和检验或χ^2检验进行假设性检验,采用Kaplan-Meier法计算生存曲线。结果共收集确诊结直肠癌同时性腹膜转移的患者资料1 003例,男性575例,女性428例,年龄(58.5±14.1)岁(范围:18~92岁)。乙状结肠癌占比最大,为31.8%(292/920),合并肝、肺转移的患者比例分别为27.9%(219/784)和8.3%(64/769)。术前血液学指标以癌胚抗原检测最为普遍(87.74%,880/1 003),阳性率为64.5%(568/880)。术前影像学检查诊断腹膜转移的准确率为40.7%(280/688)。腹膜癌指数分期系统(PCI)评分<10分的患者占比最高,为59.6%(170/285)。27.0%(262/971)的患者接受完全腹腔镜手术,72.0%(588/817)的患者行原发肿瘤切除术,55.4%(253/457)的减瘤手术肿瘤细胞减灭程度(CCR)为0。21.0%(70/334)的患者术后行腹腔热灌注化疗。56.03%(562/1 003)的患者有完整随访记录,中位总体生存时间为15.0个月。与PCI≥20分患者相比,PCI<20分患者的原发肿瘤切除率更高(187/205比26/80,χ^2=105.085,P=0.000),CCR为0或1的比例更高(162/204比8/78,Z=-10.465,P=0.000)。不同手术方式的CCR存在差异(Z=-3.246,P=0.001),当拟行最大程度减瘤时,大多数术者会选择开放手术(含中转开腹)。原发肿瘤切除患者的生存时间更长(P=0.000)。结论结直肠癌同时性腹膜转移术前诊断困难,原发肿瘤切除对延长术后生存时间作用明显。结直肠癌同时性腹膜转移的规范治疗需进一步加强。Objective To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China.Methods Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed.Excel database was created which covered 77 fields of 7 parts:baseline information of patients,laboratory tests,imaging tests,chemoradiotherapy information,intra-operative findings,postoperative pathology and follow-up data.The Wilcoxon rank-sum test was used for comparison of the measurement data between groups.Theχ^2 test was used for comparison of the categorical data between groups.The survival curve was calculated by the Kaplan-Meier method.Results Of the 1 003 patients,there were 575 male and 428 female patients with the age of(58.5±14.1)years(range:18 to 92 years).In a total of 920 patients,the carcinoma of sigmoid colon was performed in 292 cases(31.8%)with the highest ratio.The proportion of patients with liver metastasis and lung metastasis were 27.9%(219/784)and 8.3%(64/769).Preoperative detection of carcino-embryonic antigen level was the most common method in China(87.74%,880/1 003),and the positive rate was 64.5%(568/880).The correct rate of preoperative imaging tests was 40.7%(280/688).The ratio of peritoneal carcinomatosis index(PCI)scores between 0 and 10 was the highest(59.6%,170/285).Two hundred and sixty-two(27.0%)patients were performed by totally laparoscopic operation in 971 patients.The resection of primary tumor was performed in 588 of the 817 patients(72.0%).In a total of 457 cases,253(55.4%)patients were performed cytoreduction which group scored completeness of cytoreduction(CCR)0.The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases(21.0%).Among 1 003 cases,562 cases(56.03%)had complete follow-up data and the median overall survival was 15 months.The primary tumor resection and the CCR scores were affected by the PCI scores.The patients underwent

关 键 词：结直肠肿瘤 肿瘤转移 腹膜 多中心临床研究 

分 类 号：R735[医药卫生—肿瘤]