结直肠癌伴穿孔的诊治体会

探讨有效地预防结，直肠癌伴穿孔的发生及合理治疗结，直肠癌伴穿孔的方法。方法：用ｘ＾２检验分析７４２例患者的５年生存率与其中的１１例伴穿孔患者的５年生存率。结果：全部７４２例结，直肠癌患者５年生存率为５８．６％。１１例伴穿孔患者的５年生存率仅为１８．２％，４例伴急性穿孔患者中的３例有诱发穿孔的因素。     

结直肠癌肺转移和同时性肝转移生存分析

目的分析结直肠癌单纯性肺转移和结直肠癌肝转移(不包括肝、肺同时转移)患者的生存状况及影响因素。方法回顾性分析四川省肿瘤医院2011年11月至2018年6月收治的46例结直肠癌单纯性肺转移(其中同时性肺转移22例,异时性肺转移24例)和91例结直肠癌肝转移患者的临床资料、病理特征、治疗方法及预后生存情况,分析影响生存的相关因素,采用Cox回归模型分析影响单纯性结直肠癌肺／肝转移患者生存预后的相关因素。结果46例结直肠癌肺转移患者的总体中位生存时间为58(6～104)个月,5年生存率为478％；其中手术组的中位生存时间和5年生存率显著优于化疗组(P<001)。91例结直肠癌肝转移患者的总体中位生存时间为22(3～38)个月,3年生存率为333％,5年生存率为0％;其中手术组的中位生存时间和3年生存率显著优于其他组(P<001)。Cox回归分析结果显示肝转移灶非手术及非局部治疗是影响患者预后的独立危险因素。结论结直肠癌同时性肺转移患者的生存期低于异时性肺转移。对于严格挑选的结直肠癌同时性肝或肺转移患者积极手术治疗可能改善其生存率。     

结直肠癌并发急性穿孔的处理

[目的]探讨结直肠癌并发急性穿孔处理方式。[方法]1994年至2002年11例结直肠癌伴发急性穿孔者均急诊手术，4例行I期肿瘤切除肠吻合术，6例I期肿瘤切除、远端关闭，近端造瘘术(Hartmann手术)，l例行穿孔修补术。[结果]全部病例无手术死亡。随访6—85个月，4例健在，中位生存期27．7个月。[结论]结直肠癌伴急性穿孔应以挽救生命为关键及时手术，尽量争取行I期肿瘤切除以提高生存率。     

探讨周围神经侵犯在结直肠癌患者中的预后价值

目的：确定结直肠癌患者发生周围神经侵犯的危险因素，并揭示PＮI对结直肠癌患者临床预后的影响。方法：选取本院2009年2月至2019年3月行结直肠癌根治术的605例患者临床资料和随访数据。于病理科调取符合入组条件患者的苏木精 伊红染色切片，重新读片，根据ＨＥ染色判断PＮI情况。采用统计学方法分析PＮI与各临床病理因素的关系，并对影响结直肠患者总体生存率的相关因素采用单因素和多因素CＯＸ回归分析。结果：结直肠癌患者PＮI发生率为27.1％(164/605)。结直肠癌患者发生PＮI与肿瘤分化程度，淋巴结转移显著相关，低分化肿瘤PＮI发生率明显高于中分化及高分化肿瘤，PＮI (＋)组结直肠癌阳性淋巴结的数量显著高于PＮI(－)组(24.79±14.47ｖS20.28±10.76，P＝0.006)，而与年龄、性别、体质量指数、肿瘤部位、其他恶性肿瘤病史、新辅助化疗、糖尿病病史、Ｔ分期、Ｎ分期、临床分期及脉管癌栓等相关临床病理指标无明显相关。PＮI既不是结直肠癌患者预后不良的危险因素，也不是独立预后因素。PＮI(＋)组与PＮI(－)组患者5年总体生存率及无病生存率相比差异无统计学意义(P＝0.727、P＝0.472)。结论：结直肠癌患者PＮI的发生率与肿瘤分化程度和淋巴结转移显著相关，但它既不是结直肠癌患者预后不良的危险因素，也不是独立预后因素。     

结直肠癌伴肝转移91例患者的多因素预后分析

目的：探讨结直肠癌同时性肝转移患者的预后相关因素。方法：采用多因素回归分析方法回顾性分析了91例结直肠癌同时性肝转移患者的生存因素。结果：91例结直肠癌同时性肝转移的患者中位生存期为16.8个月,1年生存率为61.54%,3年生存率为14.79%,5年生存率为8.87%。单因素分析显示原发灶手术、肝转移分期、介入治疗、放射治疗、物理治疗、化疗和新药使用与患者的生存期显著相关;多因素分析显示,肝转移分期、原发病灶手术切除、介入治疗、物理治疗对患者的预后有显著影响,是结直肠癌同时性肝转移影响预后的主要因素。结论：对于结直肠癌同时性肝转移的患者应积极切除原发病灶,进行介入、物理等综合治疗可以提高患者的生存期。     

S100A4基因差异表达与结直肠癌分化、转移及预后的关系

目的：研究S100A4基因差异表达与结直肠癌分化、转移及预后的关系。方法：应用免疫组织化学sP法检测87例结直肠癌组织及癌旁结直肠组织中S100A4蛋白，并分析S100A4蛋白表达与结直肠癌临床病理因素及术后5年生存率的关系；免疫细胞化学SP法检测3种不同分化程度的结直肠癌细胞Caco-2、HT29、HCT116的S100A4蛋白表达，RT-PCR检测该3种细胞的S100A4 mRNA表达水平。结果：在癌旁结直肠组织腺上皮中S100A4蛋白不表达；在结直肠癌组织中S100A4蛋白的表达率为64．4％（56／87）；与癌旁结直肠组织比较。差异有统计学意义（P〈0．01）。S100A4蛋白在结直肠癌中的表达与临床分期、淋巴结转移和5年生存率有关（P〈0．05），与其他临床病理因素无关（P〉0．05）；3种结直肠癌细胞均表达S100A4蛋白;S100A4 mRNA表达水平的顺序依次为：HCT116最高，HT29次之，Caco-2最低；三者S100A4 mRNA表达水平差异有统计学意义（P〈0．01）。结论：S100A4基因表达和结直肠癌的发生发展、分化、侵袭转移及预后密切相关；S100A4蛋白可作为判定结直肠癌临床病理特征及判断预后的重要指标之一，也可能作为新的生物标志物及治疗结直肠癌浸润转移的潜在靶目标。     

结直肠癌肺转移和同时性肝转移生存分析

目的分析结直肠癌单纯性肺转移和结直肠癌肝转移(不包括肝、肺同时转移)患者的生存状况及影响因素。方法回顾性分析四川省肿瘤医院2011年11月至2018年6月收治的46例结直肠癌单纯性肺转移(其中同时性肺转移22例,异时性肺转移24例)和91例结直肠癌肝转移患者的临床资料、病理特征、治疗方法及预后生存情况,分析影响生存的相关因素,采用Cox回归模型分析影响单纯性结直肠癌肺/肝转移患者生存预后的相关因素。结果 46例结直肠癌肺转移患者的总体中位生存时间为58(6～104)个月,5年生存率为47.8%;其中手术组的中位生存时间和5年生存率显著优于化疗组(P0.01)。91例结直肠癌肝转移患者的总体中位生存时间为22(3～38)个月,3年生存率为33.3%,5年生存率为0%;其中手术组的中位生存时间和3年生存率显著优于其他组(P0.01)。Cox回归分析结果显示肝转移灶非手术及非局部治疗是影响患者预后的独立危险因素。结论结直肠癌同时性肺转移患者的生存期低于异时性肺转移。对于严格挑选的结直肠癌同时性肝或肺转移患者积极手术治疗可能改善其生存率。     

结直肠肿瘤治疗新进展——结直肠癌外科治疗应坚持肿瘤治疗原则

结直肠癌是常见的恶性肿瘤之一。目前全球结直肠癌的发病率和死亡率分别居于第3、4位。结直肠癌每年新发病例和死亡人数分别为123万和60万。2013年报道美国结直肠癌患者5年总生存率约为60％,Ⅰ～Ⅱ期、Ⅲ期和Ⅳ期患者的5年生存率分别约为90％、70％和10％。肿瘤分期越早预后越好。早期发现、早期诊断及早期治疗是降低结直肠癌患者死亡率的重要因素。     

国内单中心1321例结直肠癌预后的临床分析

目的 探讨中西方结直肠癌治疗及预后的差别.方法 对本中心的1 321例结直肠癌患者临床病例资料及随访数据进行分析,并与Surveillance,Epidemiology and End Resluts (SEER)数据库和European Cancer Registry(EUROCARE-4)数据库进行比较,研究中西方结直肠癌预后的差异.结果 1 321例接受结直肠癌切除手术患者5年总生存率为62.6％,高于中国平均水平(47.2％),与SEER数据库的64.7％和EUROCARE4的56.8％相似.各分期中,与SEER数据比较,人组数据虽然生存率较低,但分期方式受到新辅助治疗降期等因素影响,其差异不能说明预后更差.结论 本中心结直肠癌手术患者预后好于中国结直肠癌患者预后的平均水平,与西方国家结直肠癌患者预后相似.     

基于TME的直肠癌保留植物神经根治术及其效果分析

目的：探讨基于全直肠系膜切除（TME）的中下段直肠癌保留植物神经根治术对局部复发率、生存率和术后生存质量的影响。方法：回顾性分析125例基于TME的中下段直肠癌保留植物神经根治术与60例未保留植物神经的根治术患者的5年生存率和局部复发率，及排尿功能和性功能。结果：无手术死亡病例。A组排尿功能障碍13例（占10．4％），性功能障碍20例（占16．0％）；B组分别为35例（占58．3％）和41例（占68．3％）；两组比较，P〈0．005。局部复发率：A组为8．8％（11／125），B组为16．7％（10／60），两组比较，P〉0．05。5年生存率：A组60．8％（76／125），B组46．7％（28／60）。结论：保留植物神经的直肠癌全直肠系膜切除术，在不增加局部复发率和降低5年生存率的同时，可以减少病人排尿功能和性功能障碍的发生，提高病人术后的生存质量。     

结直肠癌联合脏器切除60例分析

１９８０年至１９８９年我院肿瘤种共进行了７４２例结、直肠癌切除手术，其中６０例行联合脏器切除，５年生存率达３０．０％，手术并发症发生率４６．６％，死亡２例。资料结果提示，尚无明显远处转移而局部毗邻脏器浸润的结、直肠癌宜行联合脏器切除，可获得较好的疗效。     

Surgery in perforated pediatric intestinal lymphoma

BackgroundPerforation is the most common surgical complication in pediatric intestinal lymphoma. During operation, many surgical decisions are debatable.AimTo assess the outcome of surgical management of perforated pediatric intestinal lymphoma.Patients and methodsThis is a retrospective analysis of all pediatric patients (<18 years old) with intestinal lymphoma treated in our hospital between July 2007 and June 2017. Risk factors for perforation, type of management and outcome in cases of intestinal perforation were analyzed.ResultsThe study included 240 patients with intestinal lymphoma. Perforation developed in 16 patients (6.7%) with a median age of 5.3 (range: 2.8–15.7) years. Most of the patients (92.5%) had Burkitt lymphoma. The ileum was the most common site of perforation (n = 10). Perforation occurred at presentation (n = 2), during induction (n = 10), during maintenance chemotherapy (n = 2), or at relapse (n = 2). Primary resection anastomosis was done in 12 patients. The resected specimen showed a viable tumor in ten patients. Wound infection (25%) and dehiscence (12.5%) were the most common postoperative complications. The 5-year overall and event-free survivals of patients with perforation were 78.6% and 71.4%, respectively, compared with 85.5% and 81.2% in non-perforated patients; the difference was not significant (p = 0.374 and p = 0.270, respectively).ConclusionPerforation is not an adverse prognostic factor for survival in pediatric intestinal lymphoma patients. Primary resection anastomosis seems to be a safe option if complete tumor resection is feasible.     

Two-stage radical gastrectomy for perforated gastric cancer

Introduction Perforation represents a severe complication of gastric cancer. Because it is rare, only few data are available regarding treatment and prognosis. Methods Patients with perforated gastric cancer were identified from two prospective registers of gastric cancer and of gastroduodenal ulcer. Results Between February 1982 and June 1999 23 patients with perforated gastric cancer were treated surgically. This corresponds to only 1.8% of 1273 patients presenting with gastric cancer, but to 14% of 161 patients presenting with gastric perforation during this time period. Overall, post-operative mortality was 13% (3/23). Initially, 21 patients had palliative operations. Two patients had a potentially curative procedure at the emergency operation and one of the two died post-operatively. Another six patients had potentially curative gastrectomy at a second stage and no patient died post-operatively. The 5-year overall survival was estimated at 50% for all eight curatively-treated patients. Median survival of palliatively treated patients was 6 months.Conclusions Perforation of the stomach should raise suspicion of malignancy, particularly in elderly patients. At the time of perforation radical gastrectomy with lymphadenectomy is mostly not advised, either because a diagnosis of gastric cancer is not confirmed or because the patient's condition does not allow extended surgery. In this situation it is suggested to consider a two-stage procedure and direct the primary operation at the treatment of perforation and peritonitis. Tumour staging can be completed when the patient has recovered and a radical operation with curative intent can be planned without compromising long-term prognosis. Our observations and a review of the literature confirm that perforation of gastric cancer does not preclude long-term survival per se in a substantial number of patients.     

大肠癌中C-Met VEGF及其受体KDR 的表达与预后的相关性*

目的:探讨C-Met 、VEGF及其受体KDR在大肠癌组织中的表达与预后的关系,为判断大肠癌患者预后提供参考。方法:应用免疫组织化学法检测60例大肠癌标本中C-Met 、VEGF及其受体KDR的表达情况。随访统计5 年生存率。结果:C-Met 、VEGF及其受体KDR在大肠癌组织中的表达阳性率分别为43.3% 、61.7% 及68.3% ;三者在大肠癌组织中的表达与患者的年龄及性别无明显相关（P>0.05）,与肿瘤侵袭深度、是否淋巴结转移及Dukes分期密切相关（P 均<0.05）。 C-Met 、VEGF及KDR阳性者5年生存率分别为42.3% 、43.2% 及51.2% ,阴性者5 年生存率分别为73.5% 、87.0% 及78.9% ,两组差异有统计学意义（P<0.05）。 Cox回归生存分析显示:对于大肠癌患者,VEGF、KDR及C-Met 均是独立危险因素;联合检测VEGF、KDR及C-Met ,是预测大肠癌预后很好的指标。结论:C-Met 、VEGF及其受体KDR在大肠癌患者组织中的表达与大肠癌的发生、发展有关,三者均阳性表达提示患者预后差,可作为评价预后的指标。      

结直肠癌肝转移患者预后因素分析

目的：探讨结直肠癌肝转移患者外科治疗后的预后影响因素及临床意义.方法：分析本院1995年1月至2000年12月158例经病理证实、随诊资料完整的结直肠癌肝转移病例临床资料，对影响患者生存的12项因素进行单因素、多因素分析.结果：根治性切除67例（42.4%）、姑息性切除53例（33.5%）、探查术或最佳支持治疗38例（24.1%） 术后化疗82例（51.9%）、术后未化疗76例（48.1%） 切缘阴性132例（83.5%）、切缘阳性26例（16.5%） 中位生存期41个月，5年生存率27.0%.单因素分析表明，外科治疗方式（P=0.013＜0.05）、原发瘤N分期（P=0.003＜0.05）、转移灶大小（P=0.037＜0.05）及分布（P=0.032＜0.05）和切缘（P=0.000＜0.001）、辅助性治疗（P=0.041＜0.05）为预后影响因素 多因素回归分析显示，仅有原发瘤N分期（P=0.004＜0.05）为预后的独立影响因素，淋巴结转移的相对危险度为2.086.结论：结直肠癌肝转移的根治性切除是患者获得长期生存的有效治疗手段 对于结直肠癌肝转移患者应恰当选择病例，力求一期根治性切除 不适合一期根治性切除者，应采用新辅助化疗手段，降级肿瘤的临床病理分期，以期提高根治性切除率，提高患者生存期.     

AEG-1 is associated with tumor progression in nonmuscle-invasive bladder cancer

This study was designed to explore the influence of intra-operative perforation on prognosis of low rectal cancer after APR and to investigate the risk factors of perforation. Perforation is not scarce during the procedure of abdominoperineal resection (APR). There is no consensus on perforation rate and related risk factor for APR. Data of 925 patients who received APR for low rectal cancer between January 2000 and August 2008 were reviewed. The intra-operative perforation rate was 7.4 % (68/925). The recurrence rate was 28.6 % in patients with intra-operative perforation compared with 6.8 % in patients with no perforation (P < 0.001); 5-year survival rate in patients with perforation was 41.4 and 66.3 % in patients with no perforation. Univariate analysis showed that intra-operative perforation affected recurrence rate and survival significantly (P < 0.001, P < 0.001); multivariate analysis revealed that intra-operative perforation was an independent prognostic factors for recurrence (RR: 3.087, P < 0.001), while not for survival (RR: 1.331, P = 0.051). Patients aged more than 70 years, T3 tumor and treated by general surgeon had higher perforation rate (P = 0.001, P = 0.004, P = 0.008). Intra-operative perforation affected the prognosis of low rectal cancer after APR significantly. Elderly patient aged more than 70 years, T3 tumor and general surgeon who performed operation were three risk factors of increased perforation rate.     

The use of cancer registry data to study preoperative carcinoembryonic antigen level as an indicator of survival in colorectal cancer

A retrospective analysis of survival results for colorectal cancer patients in Illinois was performed by the Cancer Incidence and End Results Committee of the Illinois Division of the American Cancer Society. Cancer registry data on 1,774 patients from 63 hospitals were used to investigate whether the preoperative level of serum carcinoembryonic antigen (CEA) was a prognostic indicator of survival for cancers diagnosed between 1976 and 1978. A direct relationship was found between the preoperative level of serum CEA and both the thickness and stage of the tumor at initial diagnosis. For Stage B2/3 colorectal cancer, the actuarial survival curves corresponding to normal, elevated, and markedly elevated CEA levels were significantly different (p less than 0.0001). The five-year survival rates for these patients were 61, 50, and 32 percent, respectively. Similar trends for patients with Stage C2/3 cancer were observed (p = 0.0058). The corresponding five-year survival rates were 44, 30, and 26 percent, respectively. Using a statewide cancer registry system, the analysis suggested that the preoperative level of serum CEA was an indicator of survival in patients with colorectal cancer, independent of the stage of disease at diagnosis.     

高龄梗阻性结直肠癌的外科治疗

目的:探讨影响70岁以上高龄结直肠癌伴肠梗阻患者的外科治疗及预后因素。方法:回顾性分析中国医学科学院肿瘤医院腹部外科1992年1 月至2001年12月间收治的31例70岁以上高龄梗阻性结直肠癌患者的临床病理资料。采用Kaplan-Meier 法进行生存分析,Log-rank 检验进行统计学比较;应用Cox 比例风险模型进行多因素分析,对外科治疗及影响预后的因素进行分析。结果:全组患者中位年龄74岁,手术后并发症者7 例（22.6%）,手术后30天内死亡2 例（6.5%）。 病理类型分别为管状腺癌28例（高分化5 例,中分化16例,低分化7 例）,黏液腺癌3 例。肿瘤Dukes分期B 期8 例,C 期9 例,D 期14例。全组5 年生存率为22.7% 。行根治性手术组的5 年生存率为44.4% ,非根治手术组的5 年的总体生存率为7.7% 。全组的中位生存期为12个月,根治性手术组的中位生存期38个月,非根治组的中位生存期9 个月。单因素分析显示:高龄、合并症、术前CEA 、术前低蛋白血症、手术时间、根治性手术、分期与预后相关。多因素分析表明高龄、术前低蛋白血症为影响老年梗阻性结直肠癌预后的独立因素。结论:高龄梗阻性结直肠癌患者行根治性切除术预后较好,年龄、术前低蛋白血症是影响其预后的独立因素。      

Long-term outcomes after laparoscopic colectomy

AIM:To evaluate long-term outcomes in a large series of patients who randomly received laparoscopic or open colorectal resection.METHODS:From February 2000 to December 2004,six hundred sixty-two patients with colorectal disease were randomly assigned to laparoscopic(LPS,n = 330) or open(n = 332) colorectal resection.All patients were analyzed on an intention-to-treat basis.Long-term follow-up was carried out every 6 mo by office visits.In 526 cancer patients five-year overall and disease-free survival were evaluated.Median oncologic follow-up was 96 mo.RESULTS:Eight(4.2%) LPS group patients needed conversion to open surgery.Overall long-term morbidity rate was 7.6%(25/330) in the LPS vs 11.1%(37/332) in the open group(P = 0.17).In cancer patients,fiveyear overall survival was 68.6% in the LPS group and 64.0% in the Open group(P = 0.27).Excluding stage Ⅳ patients,five-year local and distant recurrence rates were 32.5% in the LPS group and 36.8% in the Open group(P = 0.36).Further,no difference in recurrence rate was found when patients were stratified according to cancer stage.CONCLUSION:LPS colorectal resection was associated with a slightly lower incidence of long-term complications than open surgery.No difference between groups was found in overall and disease-free survival rates.