80岁以上高龄结直肠癌患者的术后并发症相关因素分析

目的分析80岁以上高龄结直肠癌术后并发症发生的相关因素,探讨围手术期的治疗。方法回顾性分析湖州市中心医院2008月12月至2018年12月期间收治并行手术治疗的90例80岁以上高龄结直肠癌患者的临床资料。结果择期手术79例(88%),急诊手术11例(12%);平均手术时间145.7分钟,平均获取淋巴结16.8枚,手术中平均出血量65ml。共35例(39%)出现术后并发症,其中5例患者因心肌梗死、肠瘘伴腹腔感染、呼衰、肺部感染或心衰死亡。高龄结直肠肿瘤患者术后发生并发症与有无合并肿瘤梗阻、基础疾病类型及手术方式有关(均P0.05)。结论 80岁以上高龄结直肠癌患者尽管术后并发症发生率较高,但经充分术前评估、积极治疗基础疾病以及术后处理,能够很好耐受手术。     

局部侵犯期结直肠癌扩大切除术66例的疗效分析

目的探讨局部侵犯期结直肠癌扩大切除术的疗效。方法回顾性分析1995年1月至2002年12月960例结直肠癌手术病例的临床资料,统计局部侵犯期结直肠癌的手术并发症率、围手术期死亡率、5年生存率,并用Cox回归方法对预后因素进行分析。结果局部侵犯期结直肠癌扩大切除术66例,占6.9%(66/960),手术并发症发生率27%(18/66),较结直肠癌常规手术高(χ2=8.82,P=0.002),围手术期死亡率为0。术后病理证实联合切除脏器的肿瘤侵犯率为31%(27/88),术后5年生存率为62%;联合切除脏器的粘连性质(Wald=7.42,P=0.005)、淋巴结状态(Wald=4.55,P=0.035)是影响预后的独立因素。结论局部侵犯期结直肠癌扩大切除术有较好的术后生存率,其手术并发症较常规手术高,但仍是安全术式。     

结肠癌联合胰十二指肠切除术

目的探讨结肠癌患者实施联合胰十二指肠切除术(PD)的必要性和方法。方法总结1994年1月至2002年12月间1750例结直肠癌患者中5例横结肠癌患者(0.3%)行联合PD术的临床资料。结果结肠癌联合PD术的5例患者(其中1例加肠系膜上静脉部分切除吻合)均无手术死亡。1例术后并发胰瘘和切口感染,但均康复出院。3例术后半年因肿瘤复发死亡,2例随访至今45个月和72个月仍无瘤生存。结论结肠癌侵犯胰十二指肠较少见。结肠癌联合胰十二指肠切除手术是安全的,能为部分患者提供长期生存的机会。     

结直肠癌211例外科治疗体会

目的探讨结直肠癌的外科治疗方法。方法回顾性分析2000年1月至2005年12月期间211例结直肠癌患者的外科治疗资料。结果全部患者中术后获5年随访者有71例，Dukes分期A、B及C期患者5年生存者分别为12／12例、20／31例及11／28例；直肠癌术后随访5年者局部复发率为11．8％（4／34）。扩大根治手术行侧方淋巴结清扫及保护盆腔自主神经手术者15例，其中5例患者有不同程度的性功能障碍，经治疗后有改善；10例患者有不同程度的排尿功能障碍，均经治疗后痊愈。直肠癌保肛手术占77．2％（61／79），中低位直肠癌保肛手术占60．7％（17／28）。结论结直肠癌的治疗应将肿瘤的根治始终放在第1位，结肠癌根治应规范化；全直肠系膜切除术大大减少了直肠癌手术后的局部复发率；侧方淋巴结清扫宜选择性开展；保护盆腔自主神经的手术开展有利于减少膀胱和性功能的损伤；在不降低根治原则的前提下最大限度地提高保肛率，提高患者的生活质量。     

腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术

目的 探讨腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术的可行性及临床意义.方法 回顾性分析2007年1月至12月收治的34例直肠癌患者和临床资料.所有患者施行腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术,观察手术时间、淋巴结清扣情况、术后并发症等,在术后12个月复查残尿量,并对男性患者进行问卷调查,了解该手术方式的近期疗效.结果 本组患者手术均获成功,无中转开腹.手术时间为(265±46)min;失血量为(123±27)ml;清扫淋巴结(19±3)枚;术后并发症发生率为9%(3/34).术后留置尿管时间为(5.5±1.6)d,术后12个月平均残尿量为(22.5±7.8)ml,CEA为(8.0±4.6)U/L,男性性功能障碍发生率为14%(3/21).随访至2008年8月未发现局部复发或远处转移.结论 腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术安全可行,值得在临床上推广应用.     

结直肠癌患者误漏诊68例临床分析

目的探讨结直肠癌误漏诊的原因及预防措施,以减少结直肠癌的误漏诊。方法对1998年12月至2008年8月收治的68例结直肠癌误漏诊的病例进行回顾性分析。结果在68例结直肠癌误漏诊的患者中,有56例患者首诊为急、慢性阑尾炎,占82.3%;其中30例患者急诊手术中发现并存病灶行一期手术治疗;5例首诊为阑尾周围脓肿,抗炎治疗后发现并存病灶行一期手术;有21例因首次手术遗漏并存病灶而再次手术治疗。5例直肠癌患者误诊为内痔,占7.4%。7例患者误诊为原发性卵巢癌,占10.3%,于术后发现原发病灶需再次手术。随访结果生存期超过2年者34例（50%,34/68）,其中超过5年者3例（4.4%,3/68）。结论提高对结直肠癌的认识,需要详细询问病史,完善术前必要的检查,术中仔细探查及术后定期复诊,可以减少结直肠癌的漏诊。     

结直肠癌肝转移的外科治疗

目的探讨结直肠癌肝转移的手术疗效。方法1996年8月～2000年8月手术治疗结直肠癌肝转移患者31例,行原发癌与转移癌同时切除者9例,结直肠癌根治术后6月再切除肝转移灶者18例;切除肝转移灶后2月再切除原发病灶者4例。原发灶行右半结肠切除5例,横结肠切除4例,左半结肠切除7例,Dixon术12例,Miles术3例。肝转移灶行左外叶切除5例,左半肝切除2例,右后叶切除4例,右前叶切除2例,左或右肝不规则切除18例。结果全组无手术死亡。术后粘连性肠梗阻1例,切口感染3例,经对症治疗后均痊愈出院。平均随访6.4(0.5～8)年,1、2、5年生存率分别为100%、80.6%、29.0%。同期手术者与分期手术者5年生存率分别为33.3%和27.3%,无统计学差异(P>0.05)。结论对结直肠癌肝转移患者应积极争取手术切除,术后可配合其他综合治疗;对原发灶早期诊断、早期手术治疗及辅助化疗有利于防止结直肠癌肝转移。     

结直肠癌伴腹膜扩散的临床病理分析及手术干预对预后的影响

目的 探讨结直肠癌腹膜扩散患者的临床病理因素及手术干预对其预后的影响.方法 回顾性分析1994年8月至2006年12月间结直肠癌数据库中患者的临床资料及随访结果,比较结直肠癌无腹膜扩散和有腹膜扩散患者的临床病理特点,并分析结直肠癌不同程度腹膜扩散和不同手术方式患者的预后.结果 2019例原发性结直肠癌患者中150例(7.4%)发生腹膜扩散.在诸多临床病理因素中,浆膜浸润、腹水、淋巴结转移、肿瘤分化程度、组织分型、瘤周径、癌性肠梗阻、Dukes分期与腹膜扩散有关,多因素分析显示浆膜浸润、肿瘤分化程度与腹膜扩散有关.腹膜转移患者1、3、5年生存率分别为70.4%、38.1%、30.2%;根治性手术切除组1、3、5年各时点生存率明显高于姑息手术和减状切除组(P<0.05).结论 结直肠癌伴腹膜扩散患者临床病理情况较差,局限性腹膜扩散患者预后较腹膜广泛转移者好,尽量手术切除腹膜转移病灶可提高患者的预后.     

老年结直肠癌患者术后近期门诊随访的影响因素分析

目的探讨影响老年结直肠癌患者术后近期门诊随访的因素,以期为提高随访效率和质量提供一定的依据。方法回顾性分析2009年1月至2010年5月期间于我院胃肠外科中心行手术治疗的253例老年结直肠癌患者的资料,利用医院信息系统统计其术后半年内门诊随访日期和随访次数,计算随访率,分析可能影响随访次数和随访率的因素。结果本组患者总体随访率为84.2%(213/253),随访次数(4.08±0.03)次/人(0～24次/人)。随访次数方面:本市内患者高于本市外患者,有内科合并症者高于无内科合并症者,有术后并发症者高于无术后并发症者,造口患者低于非造口患者,其差异均有统计学意义(P<0.05),而其余各因素的组间差异均无统计学意义(P>0.05)。随访率方面:根治术患者高于非根治术者,造口患者低于非造口患者,差异均有统计学意义(P<0.05),而其余各因素组间差异均无统计学意义(P>0.05)。结论老年结直肠癌患者术后近期门诊随访情况尚不容乐观,可能影响其随访率或随访次数的因素包括患者居住地与就医地点的距离、有无内科合并症、有无术后并发症、是否行根治术以及是否造口。     

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目的探讨老年人结直肠癌的外科治疗。方法对复旦大学附属肿瘤医院1985年1月至2003年12月间手术治疗的266例年龄≥75岁的老年人结直肠癌病例资料,进行临床和病理资料的回顾性分析。结果266例中,男性151例,女性115例,年龄75~91岁。病变部位以直肠和乙状结肠多见,占69.2%,但右半结肠癌仍占22.2%。94例(35.3%)术前存在心血管疾病、糖尿病等合并症。215例(80.8%)行根治性手术,35例(13.2%)行姑息性手术治疗。术后30例(11.3%)出现肠梗阻、出血、感染等并发症,其中3例(占1.1%)手术后死亡。全组随访1个月至16年,5年存活率51.3%。结论虽然老年人结直肠癌中术前合并症和术后并发症的发生率较高,但在重视围手术期的检测和处理后手术死亡率并未增加,术后5年存活率仍可达50%以上。因此,对老年人结直肠癌积极的临床诊治不容忽视。     

Risk Factors for Excess Mortality in the First Year After Curative Surgery for Colorectal Cancer

Background

Thirty-day mortality after surgery for colorectal cancer may vastly underestimate 1-year mortality. This study aimed to quantify the excess mortality in the first postoperative year of stage I?CIII colorectal cancer patients and to identify risk factors for excess mortality.

Methods

All 2,131 patients who were operated with curative intent for stage I?CIII colorectal cancer in the western region of the Netherlands between January 1, 2006, and December 31, 2008, were analyzed. Thirty-day mortality and relative survival were calculated. In addition, relative excess risk (RER) of death was estimated by a multivariable model.

Results

Thirty-day mortality was 4.9%. One-year mortality was 12.4%. Risk factors for excess mortality in the first postoperative year for colon cancer patients were emergency surgery (excess mortality 29.7%, RER 2.5, 95% confidence interval 2.5?C5.0), a Charlson score of >1 (excess mortality 12.6%, RER 2.3, 95% confidence interval 1.5?C3.7), stage II or III disease (excess mortality 14.9%, RER 3.9, 95% confidence interval 1.9?C8.1), and postoperative adverse events (excess mortality 22.6%, RER 2.1, 95% confidence interval 1.4?C3.2).

Conclusions

The 30-day mortality rate highly underestimates the risk of dying in the first year after surgery, with excess 1-year mortality rates varying from 15 to 30%. This excess mortality was especially prominent in patients with comorbidities, higher stages of disease, emergency surgery, and postoperative surgical complications.     

外周血SEPT9基因甲基化检测在结直肠癌筛查及术后随访中的意义分析

目的探讨外周血SEPT9基因甲基化检测在结直肠癌筛查及随访中的应用。 方法回顾性分析2014年10月至2015年12月接受结直肠癌筛查人群共计783例,其中确诊结直肠癌患者72例,非结直肠癌患者711例。对所有纳入患者进行外周血SEPT9甲基化检测和病理检查。以病理诊断为金标准,采用ROC曲线分析SEPT9阳性对结直肠癌的诊断价值,术后随访1年,观察外周血SEPT9基因甲基化和患者生存情况的关系。应用SPSS 23.0软件进行统计学分析,性别、年龄段、病变位置、TNM分期等资料以[例(%)]表示,比较采用卡方检验,以P<0.05为差异有统计学意义。 结果结直肠癌患者SEPT9基因甲基化(70.8%)显著高于非结直肠癌患者(13.5%);SEPT9基因甲基化在TNM分期Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期结直肠癌患者的阳性率依次为：47.4%、 69.2%、 88.9%、 88.9%。ROC曲线分析显示,SEPT9的AUC＝0.787,高于CA125和CA199(P<0.05),其诊断结直肠癌的灵敏度为86.5%,特异度为70.8%。术后随访1年发现,88.2%的SEPT9基因甲基化阳性患者在结直肠癌根治术后转为阴性,与SEPT9甲基化转阴性的患者相比较,SEPT9甲基化未转为阴性的患者预后较差。 结论SEPT9基因甲基化检测可能作为评估结直肠癌风险和预后的一项重要检测指标。     

保肛术联合放、化疗治疗低位中晚期直肠癌的临床观察

目的探讨保肛术联合放、化疗对低位或超低位中晚期直肠癌的临床疗效。方法 2006年8月至2010年12月在我院行保肛术的低位或超低位直肠癌患者56例(保肛手术组),以及同期行Miles手术的直肠癌患者64例(Miles手术组),比较两组患者术中、术后一般情况以及随访两年复发和死亡情况。结果保肛手术组手术时间、术中出血量和住院时间均显著低于Miles手术组,差异具有统计学意义(P<0.05);而两组间术后排气时间及术后留置导尿管时间差异无统计学意义(P>0.05)。保肛手术组2年后复发率为14.3%,死亡率为23.2%,Miles手术组复发率为14.1%,死亡率为23.4%,两组相比,差异无统计学意义(P>0.05)。结论保肛手术联合放、化疗可以显著提高低位或超低位中晚期直肠癌患者的生活质量,并且近期疗效和远期疗效与miles手术并无差异。     

Improving colorectal cancer follow-up: the dedicated single-visit colorectal cancer follow-up clinic

OBJECTIVE: To assess the effectiveness of the dedicated single-visit colorectal cancer follow-up clinic in improving postoperative surveillance. PATIENTS AND METHODS: Data of follow-up of 137 consecutive patients with colorectal cancer treated by the senior author over a 3 year period were obtained. Surveillance over three periods in time were analysed: (i) before the establishment of a protocol; (ii) following the implementation of a protocol for follow-up of colorectal cancer with liver ultrasound and colonoscopy; and (iii) following the establishment of the dedicated single-visit colorectal cancer follow-up clinic. RESULTS: The single-visit colorectal cancer follow-up clinic has reduced the mean time to the interventions (from 12.1 months to 6.0 months for the liver ultrasound and from 8.7 months to 6.4 months for the colonoscopy). In addition, the percentage of patients having their liver ultrasound within the targeted time has increased from 14% to 55%. The percentage of patients having their colonoscopy within the targeted time has also increased from 50% to 77%. The percentage who missed their liver ultrasound has been reduced from 57% to 0%. The percentage of patients who missed their colonoscopy has also been reduced from 36% to 3%. CONCLUSION: The dedicated single-visit colorectal cancer follow-up clinic improves the postoperative surveillance of patients with colorectal cancer.     

Differences between proximal and distal obstructing colonic cancer after curative surgery

Aim To study any possible differences in morbidity, mortality and overall survival rate after curative surgery for obstructive colon cancer according to tumour location. Method From January 1994 to December 2006, patients with colonic cancer presenting as obstruction were analysed. The two groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. In relation to the surgeon specialization, patients were operated on by a colorectal surgeon and by a general surgeon. Postoperative morbidity and mortality and cancer‐related survival at 3 years were analysed. Results Of the 377 patients included in the study, there were 173 patients (45.9%) in the proximal group and 204 patients (54.1%) in the distal group. The global morbidity was 54.9% without differences in postoperative morbidity except for anastomotic leakage, which was higher in the proximal group (P < 0.014). No differences in postoperative mortality were observed. After patients were stratified by the tumour node metastasis system, the differences between the groups, with respect to 3‐year overall survival, cancer‐related survival and probability of being free from recurrence, did not reach statistical significance. The overall survival after radical surgery for colonic obstruction was 57.6%. Conclusion Mortality and morbidity after emergency surgery for obstructing colon cancer are high. Specialization in colorectal surgery influences postoperative results in terms of lower anastomotic dehiscence rate after emergency proximal colon resection. After radical surgery, tumour location does not appear to influence the prognosis of obstructive colon cancer.     

腹腔镜联合开腹同期切除结直肠癌伴肝转移的可行性分析

目的探讨腹腔镜联合开腹同期切除手术方式在治疗结直肠癌伴肝转移的临床价值。方法选取2009年1月至2012年12月我院34例术前确诊为结直肠癌伴肝转移患者,其中19例行腹腔镜联合开腹同期切除结直肠癌及肝转移病灶作为治疗组,15例行传统开腹同期切除为对照组,观察两组近期疗效,对手术时间、术中出血量、术后首次排气时间以及术后并发症进行对比分析。结果 19例治疗组患者手术时间为(97±2)min,术中出血量为(106±2)mL,术后首次排气的时间为(2.65±1.58)d,住院时间为(11.26±1.89)d,均优于对照组患者(P<0.05)。治疗组的并发症发生率为10.53%,明显低于对照组的33.33%(P<0.05)。结论同期腹腔镜联合开腹手术治疗结直肠癌及肝转移是安全有效的,且术后恢复快,住院时间短,并发症发生率低,较传统开腹手术更加安全可靠,能为部分结直肠癌晚期患者的治疗提供了较好的选择方案。     

T4胃癌根治切除术患者预后的分析

目的：探讨T4胃癌根治切除术患者的生存情况及预后影响因素。 方法：对2007年1月—2011年12月收治的有完整临床及随访资料的183例T4胃癌根治切除术患者行回顾性分析。 结果：全组患者1,3,5年累积生存率分别为92%,60%,42%,单因素分析显示,淋巴结转移率、pN分期、肿瘤浸润深度、组织学类型与患者术后生存率有关（均P<0.05）;多因素分析显示,淋巴结转移率、pN分期、肿瘤浸润深度是影响患者预后的独立危险因素（均P<0.05）。 结论：淋巴结转移率、pN分期、肿瘤浸润深度是影响T4胃癌根治切除术患者生存的独立预后因素。     

Laparoscopic surgery for stage I colorectal cancer

Background: This study analyzed the short- and long-term outcomes of laparoscopic surgery (LS) in patients with stage I colorectal cancer. Methods: A total of 130 patients with stage I colorectal cancer underwent LS between 1992 and 1999. Median follow-up was 61 months (range, 30–114). Results: Oral intake was started on median postoperative day 1, and the median postoperative hospital stay was 8 days. Postoperative complications included wound sepsis in eight patients (6.2%), anastomotic leakage in four patients (3.1%), and bowel obstruction in three patients (2.3%). Five patients developed recurrences. No port site recurrences were observed. The calculated 5-year survival rate was 97.9%. Conclusion: LS was shown to be technically feasible and oncologically sound for the treatment of patients with stage I colorectal cancer, and favorable short- and long-term outcomes were obtained.     

Laparoscopic Bowel Resection in the Setting of Metastatic Colorectal Cancer

Background This study aimed to review the outcomes of laparoscopic colorectal resection for patients with stage IV colorectal cancer. Methods From the prospectively collected database for patients who underwent surgery for colorectal cancer in our institution, those with stage IV colorectal cancer who underwent elective resection of tumor during the period from January 2000 to June 2006 were included. The outcomes of those with laparoscopic resection were reviewed and comparison was made between patients with laparoscopic and open resection. Results A total of 200 patients (127 men) with median age of 69 years (range: 25–91 years) were included, and 77 underwent laparoscopic resection. Conversion was required in ten patients (13.0%) and all except one conversion were due to fixed or bulky tumors. There was no operative mortality in the laparoscopic group. The complication rate was 14% and the median postoperative hospital stay was 7 days. When patients with laparoscopic resection were compared with those with open operations, there was no difference in age, gender, comorbidity, or tumor size between the two groups. However, the complication rate was significantly lower in those with laparoscopic resection (14% versus 32%, P = 0.007) and the median hospital stay was significantly shorter (7 days versus 8 days, P = 0.005).The operative mortalities and the survivals were similar in the two groups. Conclusions Colorectal resection can be performed safely in patients with stage IV colorectal cancer. The operative outcomes in terms of complication rate and hospital stay compare favorably with patients with open resection. Presented in the Scientific Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons on 18–22 April 2007 in Las Vegas, Nevada, USA.     

局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期结果

目的　评估局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期效果和应用价值。　方法　对1994年 1月至 1998年 12月间采用该术式治疗的 16例伴癌性胸水肺癌患者进行定期随访 ,了解患者生活质量、复发情况和生存时间。计算术后中位数复发和中位数生存时间。　结果　本组无手术死亡 ,无严重手术并发症。术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解 ,恶病质迅速消失 ,未见胸水复发 ,但后期均发生远处脏器转移。术后肿瘤复发距手术时间 3～ 36个月 ,中位数复发时间 12个月。随访至 2 0 0 0年 8月 ,所有病例死亡 ,存活期 7～ 39个月。存活 1年以上 15例 ,1年生存率 94% ;存活 18个月以上 13例 ,生存率 81% ;存活 2年以上 7例 ,生存率 44 % ;存活 3年以上 2例 ,生存率 13% ;中位数生存期 2 1.5个月。　结论　此术式控制胸水、缓解症状效果肯定。术后晚期均发生远处脏器转移 ,但其中位数生存期明显长于仅做姑息性肺内癌灶切除或内科治疗患者 ,且长于全胸膜肺切除术。本术式有推广应用价值