直肠癌经直肠取标本手术成功的影响因素分析  

Analysis on clinical factors affecting transrectal natural orifice specimen extraction in rectal cancer surgery

作　　者：黄贲 周主青[1] 周煌[2] 刘孟承 杜涛[1] 鲁兵 韩俊毅[1] 高玮 朱哲 傅传刚 Huang Ben;Zhou Zhuqing;Zhou Huang;Liu Mengcheng;Du Tao;Lu Bing;Han Junyi;Gao Wei;Zhu Zhe;Fu Chuangang(Department of Colorectal Surgery,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China;Department of Medical Imaging,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China)

机构地区：[1]上海市东方医院胃肠肛肠外科,200120 [2]上海市东方医院医学影像科,200120

出　　处：《中华胃肠外科杂志》2020年第5期480-485,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81702961);中央高校基本科研业务费专项资金资助(22120180033);上海市科委医学引导类科技支撑项目(19411966500);上海市浦东新区卫生系统重点专科建设资助(PWZzk2017-26)。

摘　　要：目的:分析直肠癌腹腔镜直肠前切除术经直肠取出标本的影响因素。方法:本研究采用回顾性病例对照研究方法。检索上海市东方医院直肠癌患者的数据库,收集2017年1—12月期间,行腹腔镜直肠前切除经直肠取出标本成功和未成功患者的病例资料。病例纳入标准:(1)盆腔MRI评估肿瘤≤7 cm;(2)体质指数(BMI)≤30 kg/m 2;(3)未接受过新辅助放化疗;(4)无肛门狭窄。分析经直肠取标本成功情况,并收集年龄、性别、BMI、肿瘤梗阻、肿瘤距肛缘距离、腹部手术史,盆腔MRI测量的肿瘤最大直径和直肠系膜前后径厚度(AP)等临床资料,采用χ^2检验进行单因素分析,用多因素logistics模型分析与经直肠取标本有关的临床因素。结果:共208例直肠癌患者纳入本研究,男性132例,女性76例。年龄(63±11)岁,肿瘤最大直径中位数为3.8(P25,P75:3.0,5.0)cm。66例(31.7%)成功经直肠标本取出标本。单因素分析显示,BMI≤25.0 kg/m 2(χ^2=7.420,P=0.006)、无肿瘤梗阻(χ^2=8.972,P=0.003)、肿瘤距肛缘距离<5.0 cm(χ^2=14.960,P<0.001)、肿瘤最大直径≤5.0 cm(χ^2=18.495,P<0.001)以及AP≤6.0 cm(χ^2=34.612,P<0.001)与标本经直肠取出成功有关(均P<0.05)。而性别、年龄、腹部手术史等与标本经直肠取出成功与否无关(均P>0.05)。多因素分析显示,BMI≤25.0 kg/m 2(OR=2.32,95%CI:1.06~5.06,P=0.034)、无肿瘤梗阻(OR=3.01,95%CI:1.82~6.69,P<0.001)、肿瘤距肛缘距离<5.0 cm(OR=3.73,95%CI:1.22~11.43,P=0.021)、肿瘤最大直径≤5.0 cm(OR=4.43,95%CI:1.39~14.09,P=0.012)、AP≤6.0 cm(OR=4.30,95%CI:2.02~9.18,P<0.001)是直肠前切除术经直肠标本取出成功的独立保护因素。结论:术前综合评估BMI、肿瘤梗阻、肿瘤距肛缘距离、肿瘤最大直径和AP等临床因素,有助于选择合适的直肠癌病例进行经自然腔道取标本手术。Objective To identify the factors associated with successful transrectal specimen extraction after laparoscopic rectal cancer resection.Methods A retrospective case-control study was conducted.Clinical data of rectal cancer patients who did or did not successfully undergo transrectal specimen extraction in Shanghai East Hospital between January 2017 and December 2017 were retrieved through the rectal cancer database of Shanghai East Hospital.Case inclusion criteria:(1)tumor size≤7 cm by pelvic MRI;(2)body mass index(BMI)≤30 kg/m2;(3)no history of neoadjuvant chemoradiotherapy;(4)no anal stenosis.Clinical data including age,gender,BMI,tumor obstruction,distance from tumor to anal verge,history of abdominal operation,maximal diameter of tumor and width of mesorectum in the anteroposterior dimension measured by pelvic MRI,etc.were collected.Theχ^2 test was used to perform univariate analysis.Multivariate logistic regression was used to identify factors affecting transrectal specimen extraction.Results A total of 208 patients were included in the analysis.Of 208 patients,132 were men and 76 were women;mean age was(63±11)years old and median tumor size was 3.8(IQR,3.0 to 5.0)cm.Sixty-six(31.7%)patients completed transrectal specimen extraction successfully.Univariate analysis showed that patients who completed transrectal specimen extraction were more likely to have a lower BMI(χ^2=7.420,P=0.006),be free from malignant obstruction(χ^2=8.972,P=0.003),have a shorter distance from tumor to the anal verge(<5.0 cm)(χ^2=14.960,P<0.001),a smaller tumor size(≤5.0 cm)(χ^2=18.495,P<0.001)and a thinner mesorectum in the anteroposterior dimension(≤6.0 cm)(χ^2=34.612,P<0.001)than those who failed to perform transrectal specimen extraction.Gender,age or history of abdominal operation were not associated with the successful extraction(all P>0.05).Multivariate analysis revealed that BMI≤25.0 kg/m2(OR=2.32,95%CI:1.06 to 5.06,P=0.034),free from malignant obstruction(OR=3.01,95%CI:1.82 to 6.69,P<0.001),the distance from

关 键 词：直肠肿瘤 经自然腔道取标本手术 腹腔镜手术 磁共振成像 

分 类 号：R735[医药卫生—肿瘤]