代谢及肿瘤相关因素在结直肠癌切除术后患者异时性腺瘤发生中的作用研究  

Study on the metabolic and tumor-related risk factors for metachronous colorectal adenoma in patients undergone curative surgery for colorectal cancer

作　　者：张江国[1] 汪之沫[2] ZHANG Jiangguo;WANG Zhimo(Department of Gastroenterology,Shekou People′s Hospital,Shenzhen,Guangdong 518052,China;Department of Gastroenterology,Nanshan People′s Hospital,Shenzhen,Guangdong 518052,China)

机构地区：[1]广东省深圳市蛇口人民医院消化内科,518052 [2]广东省深圳市南山区人民医院消化内科,518052

出　　处：《重庆医学》2019年第19期3287-3291,共5页Chongqing medicine

基　　金：广东省深圳市南山区技术研发和创意设计项目分项资金教育(卫生)科技资助项目(南科研卫2017035号)

摘　　要：目的评估代谢和肿瘤相关危险因素在结直肠癌切除术后患者异时性结直肠腺瘤发生中的作用。方法对109例行结直肠癌切除术患者的临床资料及结肠镜检查结果,进行回顾性分析。结果平均随访(30.08±13.00)个月,39例(35.8%)患者发生异时性结直肠腺瘤。多因素Cox回归分析显示,代谢相关危险因素:年龄大于或等于60岁[HR=2.53,95%CI(1.08,5.93)]、长期吸烟[HR=2.37,95%CI(1.12,5.01)]、合并高血压[HR=5.42,95%CI(2.19,13.40)]、长期使用胰岛素[HR=2.73,95%CI(1.15,6.48)]及术后首次结肠镜检查间隔时间超过1年[HR=5.26,95%CI(1.84,15.08)]和肿瘤相关危险因素:原发结直肠癌为中低分化[HR=2.48,95%CI(1.20,5.11)]及原发结直肠癌伴有同时性高级别上皮内瘤变腺瘤[HR=4.36,95%CI(1.63,11.69)]的患者,其异时性结直肠腺瘤发生的风险明显增加。结论具有代谢相关危险因素和肿瘤相关危险因素的结直肠癌切除术后患者异时性结直肠腺瘤的发生风险明显增加,应增加结肠镜检查频率。Objective To assess the metabolic and tumor-related risk factors for the development of metachronous adenomas after surgery for colorectal cancer.Methods A total of 109 patients submitted to curative surgery for colorectal cancer were selected and their clinical records and surveillance colonoscopies were retrospectively analyzed.Results During an average follow-up of(30.08±13.00)months,39(35.8%)of the patients developed metachronous adenomas.Multivariate Cox regression analysis revealed that the risk of colorectal metachronous adenoma incidence significantly increased in patients with metabolic related risk factors,such as more than 60 years old[HR=2.53,95%CI(1.08,5.93)],long-term smoking[HR=2.37,95%CI(1.12,5.01)],hypertension[HR=5.42,95%CI(2.19,13.40)],long-term insulin use[HR=2.73,95%CI(1.15,6.48)],time to first surveillance colonoscopy was more than 1 year[HR=5.26,95%CI(1.84,15.08)],and tumor-related risk factors,such as poor-to-moderate differentiation primary colorectal cancer[HR=2.48,95%CI(1.20,5.11)]and primary colorectal cancer with synchronous high-grade intraepithelial neoplasia adenoma[HR=4.36,95%CI(1.63,11.69)].Conclusion The metabolic factors and tumor-related factors are demonstrated to increase the incidence of metachronous colorectal adenoma in patients with previous colorectal cancer,they should increase the frequency of colonoscopy.

关 键 词：结直肠肿瘤 异时性结直肠腺瘤 结肠镜检查 危险因素 回归分析 

分 类 号：R574.6[医药卫生—消化系统]