右半结肠癌全结肠系膜切除术后并发症及影响因素分析

目的：探讨右半结肠癌患者接受全结肠系膜切除手术（complete mesocolic excision, CME）后发生并发症的独立危险因素。方法：回顾性分析2019年1月至2021年12月我院收治190例腹腔镜下右半结肠癌行CME患者的临床资料,记录患者术后30 d内并发症发生情况,采用Clavien-Dindo分级系统对并发症发生情况及分级进行分类统计,并进一步分析影响并发症的独立危险因素。结果：共25例患者发生并发症,Clavien-Dindo分级：Ⅱ级22例次,Ⅲ级2例次,Ⅳ级1例次;并发症发生率为13.16%(25/190),严重并发症发生率为1.58%(3/190);单因素分析发现年龄、体质量指数、吻合方式、术前血钙水平和AST水平均与术后并发症的发生相关（P <0.05）;多因素Logistic回归分析显示：年龄（OR=1.887）、体质量指数（OR=2.192）、体内吻合（OR=5.382）是影响腹腔镜右半结肠癌CME术后并发症发生的独立危险因素（P <0.05）。结论：腹腔镜右半结肠癌CME术后并发症的Clavien-Dindo分级以Ⅱ级为主,年龄、体质量...     

全结肠系膜切除术治疗结肠癌的疗效分析

目的 探讨结肠癌患者应用全结肠系膜切除术治疗的临床疗效.方法 回顾性分析320例结肠癌患者临床病历资料,按照随机数字表法将其分组为对照组(传统根治术)与观察组(全结肠系膜切除术),各160例.统计2组患者手术时间、术中出血量、术后引流量、术后排气时间及术后住院时间;统计2组患者淋巴结清扫情况及术后并发症,随访2个月,统计2组患者病灶复发情况.结果 观察组术中出血量、术后排气时间、术后引流量及术后住院时间均明显少(短)于对照组,P<0.05;观察组淋巴结、阳性淋巴结、左、右半结肠淋巴结清除均明显多于对照组,P<0.05.观察组并发症率为2.50%(4/160),明显低于对照组的13.13%(21/160),P<0.05.观察组复发率为0,明显低于对照组10.63%,P<0.05.结论 全结肠系膜切除术治疗结肠癌患者疗效显著且安全.     

全结肠系膜切除术在右半结肠癌根治术中的应用

目的 评估全结肠系膜切除术(complete mesocolic excision,CME)在右半结肠癌根治术中实施的安全性和可行性.方法 回顾性分析接受CME手术(35例)和传统手术(36例)患者的临床病理资料,评估两组患者的手术效果.结果两组患者性别、年龄、肿瘤部位分布无显著性差异,平均手术时间亦无明显差异.CME手术组术中平均出血量(138.3±82.5)ml,明显少于传统手术组的(181.9±53.7)ml(P＜0.05).CME手术对术后病理分期如T分期、N分期以及TNM分期无影响,CME手术组平均活检淋巴结数目为(17.7±5.8)枚,而传统手术组为(13.6±2.5)枚,CME手术可提高术后活检淋巴结的数目(P＜0.05).两组患者术后总体并发症、感染性并发症以及非感染性并发症发生率均无显著差异. 结论CME手术治疗右半结肠癌患者安全、可行、有效,可保证切除系膜的完整性和清扫更多的淋巴结,并不增加手术的风险.     

结肠癌急诊全结肠系膜切除术的临床疗效

  目的  探讨全结肠系膜切除术（complete mesocolic excision，CME）与传统根治术在结肠癌急诊手术中的短期临床效果与安全性。  方法  回顾性分析2011年1月至2017年12月于民航总医院住院行结肠癌急诊手术53例患者的临床资料。根据入组时间和手术方式，自2014年5月起入院的患者纳入CME组（25例），之前的患者纳入传统手术组（28例）。所有患者术中均行肿瘤远近端肠管灌洗。分析不同手术方式短期临床效果的异同。  结果  CME组和传统手术组的淋巴结清扫数目分别为（31.7±2.9）枚和（19.5±4.2）枚，差异具有统计学意义（P < 0.05）。两组患者的手术时间分别为（176.0±42.3）min和（157.5±33.5）min，手术出血量分别为（148.7±74.0）mL和（128.9±50.0）mL，住院时间分别为（27.2±10.4）d和（23.1±6.3）d，首次肛门排气时间分别为（75.0±3.3）h和（75.3±3.7）h，差异均无统计学意义（P>0.05）。两组患者在病理分期、术后并发症率和死亡率等方面差异均无统计学意义（P>0.05）。  结论  CME与传统根治手术短期临床效果接近，CME淋巴结清扫更为彻底，可安全应用于结肠癌急诊患者中。      

腹腔镜全结肠系膜切除术治疗结肠癌的疗效观察

目的 探讨腹腔镜全结肠系膜切除术(CME)治疗结肠癌患者的临床疗效.方法 选取2019年3月至2020年3月间安康市中心医院收治的100例结肠癌患者,采用随机数表法分为研究组和对照组,每组50例.研究组患者采用腹腔镜CME治疗,对照组患者采用开放性结肠系膜切除术治疗,比较两组患者术前及术后24h的血清皮质醇(Cor)、...     

全结肠系膜切除在腹腔镜辅助右半结肠癌根治性切除中的应用与评价

目的探讨全结肠系膜切除术(complete mesocolic excision,CME)和血管高位结扎在腹腔镜辅助右半结肠癌根治术中的应用,并评估其效果和安全性.方法分析2010年6月至2012年2月腹腔镜右半结肠癌CME手术23例,采用历史对照的方法与传统开腹右半结肠癌根治手术32例患者对比,评估两组患者的临床病理学特点以及围手术期情况.结果23例右半结肠癌腹腔镜辅助下CME根治手术均顺利完成,无中转开腹.右半结肠癌腹腔镜辅助CME根治术患者每例患者平均清扫淋巴结(18.1±5.3)枚,传统开腹对照组平均清扫淋巴结(15.1±3.8)枚,腹腔镜CME组清扫淋巴结数目明显多于传统开腹组(P=0.013).腹腔镜CME手术组与传统开腹手术组的手术时间分别为(207.39±41.15)min和(225.16±76.62) min(P＞0.05).腹腔镜CME组术中出血量平均(124.0±32.8)ml,开腹组则高达(170±39.6)ml,差异有统计学意义(P＜0.05).腹腔镜CME组术后并发症发生率仅为13.0％,与传统手术相似,无吻合口瘘和输尿管损伤等严重并发症发生. 结论右半结肠癌腹腔镜辅助下CME及血管高位结扎安全可行,并发症发生率并无升高,但尚需大规模前瞻性随机对照研究探讨其远期疗效.     

腹腔镜下肠系膜上动脉为导向的尾侧中间入路右侧全结肠系膜切除术

<正>1病例资料患者男,44岁,H:173 cm,W:68 kg。因"上腹痛伴大便变稀、不成形4月余"入院。上腹部CT平扫+增强(图1)提示:结肠肝曲局部管壁不均匀增厚伴强化,考虑肠癌。肠镜示升结肠近肝曲见一蕈伞样新生物向腔内生长,约占4/5圈,表面溃烂,质地硬,触之易出血,活检病理示腺癌。肿瘤标志物甲胎蛋白、癌胚抗原、糖链抗原19-9在正常范围。治疗方案:腹腔     

结肠癌患者腹腔镜下全结肠系膜切除术治疗的有效性及对患者HMGB-1、MCP-1、FPG水平的影响

目的 探讨结肠癌患者腹腔镜下全结肠系膜切除术治疗的有效性及对患者HMGB-1、MCP-1、FPG水平的影响.方法 选取结肠癌患者100例,依据手术方案的不同予以分组.对照组使用开腹手术治疗,研究组腹腔镜下全结肠系膜切除术治疗.对比两组患者应激反应状况,两组血清中HMGB-1、MCP-1、FPG水平及淋巴结清扫数量,两组...     

结肠癌完整结肠系膜切除术研究进展

完整结肠系膜切除术（complete mesocolon excision,CME）是基于现代解剖学认识的一种规范化理念,其理论基础源于全直肠系膜切除术（total mesorectal excision,TME）。CME的关键是强调对结肠系膜的完整切除,从而获得被脏层筋膜包裹的原发肿瘤、营养血管及淋巴回流在内的整体标本。研究表明,CME在手术质量和术后临床疗效方面均优于传统结肠癌根治术,该术式能够增加淋巴结的清扫数量,降低术后并发症的发生率及肿瘤局部复发率,改善预后,提高患者术后生活质量。CME作为结肠癌根治手术观念上的一次革新,有望成为一种新的规范化手术方式,现本文就近年来国内外关于CME的研究进展作一综述。     

完整结肠系膜切除术治疗结肠癌患者疗效和预后分析

目的 在结肠癌的治疗中,外科手术是临床通常采用的方法,如传统根治术和完整结肠系膜切除术等.本研究对比分析完整结肠系膜切除术和传统根治术对结肠癌患者近期疗效和预后的影响.方法 选取聊城市东昌府人民医院2011-05-01-2013-05-31收治的结肠癌患者80例,其中40例患者接受完整结肠系膜切除术(CME组),40例患者接受传统根治手术(传统组),对两组患者的近期疗效、淋巴结清除数目及复发率进行统计分析.结果 CME组患者的术中出血量、术后肛门排气时间、排便时间和住院时间分别为(115.1±21.4) mL、(3.1±1.0)d、(4.5±1.4)d和(11.8±3.6)d,均优于传统组,差异有统计学意义,均P值＜0.05.CME组患者左半结肠淋巴结、右半结肠淋巴结、阳性转移淋巴结和平均淋巴结清除数目分别为(8.2±1.6)、(8.6±1.4)、(18.4±1.1)和(25.7±2.2)个,均优于传统组,差异有统计学意义,均P值＜0.05.CME组患者的并发症发生率和复发率均为5.0％(2/40),均显著低于传统组的25.0％(10/40)和22.5％(9/40),差异有统计学意义,P＜0.05;CME组患者3年生存率为92.5％(37/40),显著高于传统组的57.5％(23/40),差异有统计学意义,P＜0.05.结论 完整结肠系膜切除术较传统根治手术治疗结肠癌患者近期疗效好,淋巴结清除数目多,复发率低.     

Site-Specific Evaluation of Prognostic Factors on Survival in Iranian Colorectal Cancer Patients: A Competing Risks Survival Analysis

Background: Colorectal cancer (CRC) is one of the most malignant cancers, but prognosis varies in differentparts of the world. Knowing the prognostic factors of the cancer is clinically important for prognosis and treatmentapplication objectives. However, evaluation of these factors overall does not provide thorough understanding ofthe cancer. Therefore, this study aimed to evaluate prognostic factors of colon and rectal cancers site-specifically,via a competing risks survival analysis with colon and rectum as competing causes of death. Methods: A total of1,219 patients with CRC diagnosis according to the pathology reports of our cancer registry, from 1 January2002 to 1 October 2007, were entered into the study. Demographic and clinicopathological factors with regard tosurvival of patients were analyzed using univariate and multivariate competing risks survival analysis, utilizingSTATA statistical software. Results: The results of univariate analysis showed that gender, body mass index(BMI), alcohol history, inflammatory bowel disease (IBD), tumor size, tumor grade and pathologic stage weresignificantly associated with colon cancer and BMI, personal history of cancer, pathologic stage and the kind offirst treatment used were significantly related to rectal cancer. In the multivariate analysis, BMI, IBD, tumorgrade and pathologic stage of the cancer were significant prognostic factors for colon cancer and BMI and thekind of first treatment used were significant prognostic factors of rectal cancer. Also 1, 2, 3, 4 and 5 year andoverall adjusted survival of patients with rectal cancer was better than those of colon cancer. Conclusion: Basedon our findings, CRC is not a single entity and its sub-sites should be evaluated separately to reveal hiddenassociations which may not be revealed under general modeling.     

40岁以下青年人结肠癌的预后因素分析

目的：根据96例青年结肠癌患者的临床病理特征,对患者术后生存进行单因素及多因素分析.方法：10年间手术治疗结肠癌723例.其中40岁以下青年人96例,占13.3%.R0术（病理根治）69例,占71.9%;R1（镜下切端阳性）4例,占4.1%;R2（大体标本切端阳性）23例,占24%.左半结肠切除术43例;右半结肠切除术37例;横结肠切除术9例;前切除术7例.结果：手术死亡率为0,54例患者于术后111个月内死于复发和转移.随访期间3例发生肝转移;1例发生肺转移;5例发生骨转移.患者总的中位生存时间为77.9±5.01个月.3、5、10年总生存率分别为66.68%,58.14%及46.54%.单因素分析表明患者的年龄、术式、肿瘤的根治度、术中输血、病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移、肝转移均为预后影响因素.多因素回归分析显示影响患者术后生存的独立因素仅为术中输血及淋巴结转移.结论：影响直肠癌患者术后生存的因素为患者的年龄、术式、肿瘤的根治度、术中输血、病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移,其中独立影响因素仅有术中输血及淋巴结转移.     

Analysis on Survival and Prognostic Factors for Cancer Patients with Malignancy-associated Hypercalcemia

Objective: To explore the incidence, clinical characteristics, diagnosis and treatment strategies, prognosisof patients with malignancy-associated hypercalcemia (MAH). Methods: The data of 115 patients with MAHwho were treated at the Medical Oncology Department of Chinese PLA General Hospital from Jan., 2001 toDec., 2010 was retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier method andthe Cox proportional hazard model with statistic software SPSS 18.0. Results: The patients had blood calciumlevels ranging from 2.77 to 4.87 mmol/L. Except for 9 cases who died or were discharged within 5 days afteradmission, all other patients recovered to normal blood calcium level after treatment with bisphosphonates orintravenous hydration and diuretics; their survival after occurrence of MAH was from 1 day to 4,051 days, andthe median survival time was only 50 days. In the log-rank test, the male, renal metastasis, central nervous systemsymptoms and hypercalcemia occurring over 140 days after cancer diagnosis were predictors of poor survival(P=0.002, P=0.046, P=0.000, P=0.009). In the COX analysis, being male, central nervous system symptoms andhypercalcemia lasting over 140 days after cancer diagnosis were independent prognostic factors for survival time(RR=2.131, P=0.027; RR=3.054, P=0.002; RR=2.403, P=0.001). According to these factors, a score system wasestablished to predict the patient prognosis and adjust the treatment. Conclusion: Cancer patients with MAHhave an extremely poor median survival. Some independent factors indicate poor prognosis, including malegender, central nervous system symptoms and hypercalcemia lasting over 140 days after cancer diagnosis. Theprognostic score can serve as a reference for MAH prognosis and treatment, worthy of further investigation.     

Adjuvant Chemotherapy and Prognostic Factors in Stage II Colon Cancer - Izmir Oncology Group Study

Background: Although adjuvant chemotherapy is a standard treatment in stage III colon cancer, its benefitis not as clear for stage II patients. In this retrospective analysis, we aimed to evaluate the survival of patientswith low-risk stage II colon cancer, the efficacy of adjuvant chemotherapy in high-risk stage II colon cancerpatients, and prognostic factors in stage II disease. Materials and Methods: One hundred and seventeen patientswho were diagnosed with stage II colon cancer between January 2006 and December 2011 were included inthe study. Patients were stratified into two groups as being low-risk and high-risk according to risk factorsfor stage II disease. Adjuvant 5-fluorouracil-based chemotherapy were administered to the patients with riskfactors. Results: Ninety-four patients were treated with adjuvant chemotherapy due to high risk factors and 23were monitored without treatment. Median follow-up time was 43 months. In terms of disease free survival andoverall survival, adjuvant chemotherapy did not provide a statistically significant difference. Univariate analysisdemonstrated that bowel obstruction was the major risk factor for shortened disease-free survival, while bowelperforation and perineural invasion were both negative prognostic factors for overall survival. Conclusions:The recommendation of adjuvant chemotherapy for stage II colon cancer is not clear. In our study, it was foundthat adjuvant chemotherapy did not contribute to survival in high-risk stage II patients. Due to the fact thatprognosis of stage II patients is good, many more patients will be needed for statistically significant differences insurvival. Adjuvant chemotherapy containing 5 fluorouracil is being used to high-risk stage II patients althoughit is not a standard treatment approach.     

Association Between Primary Payer Status and Survival in Patients With Stage III Colon Cancer: An National Cancer Database Analysis

Background

Colon cancer is the third most frequent cancer diagnosis, and primary payer status has been shown to be associated with treatment modalities and survival in cancer patients. The goal of our study was to determine the between-insurance differences in survival in patients with clinical stage III colon cancer using data from the National Cancer Database (NCDB).

高龄晚期结肠癌患者术后化疗影响预后的因素分析

目的分析高龄晚期结肠癌患者术后化疗相关预后影响因素。方法选取接受术后化疗的结肠癌患者55例,计算患者生存率,并应用COX回归分析预后因素。结果 55例患者术后化疗1年和3年总生存率分别为81.8%(45/55)和7.27%(4/55),单因素分析结果显示:患者年龄、ECOG评分、淋巴结转移个数以及病变位置与晚期结肠癌患者术后化疗预后相关(P<0.05)。COX回归模型多因素分析结果显示:ECOG评分和淋巴结转移个数是影响术后化疗的独立预后因素。结论高龄晚期结肠癌患者的术后化疗预后影响因素较多,ECOG评分和淋巴结转移个数是影响患者生存的独立预后因素。     

Impact of Prognostic Factors on Survival Rates in Patients with Ovarian Carcinoma

Purpose: The aim of the present study was to invesitigate the impact of significant clinico-pathological prognostic factors on survival rates and to identify factors predictive of poor outcome in patients with ovarian carcinoma. Materials and Methods: A retrospective chart review of 74 women with pathologically proven ovarian carcinoma who were treated between January 2006 and April 2011 was performed. Patients were investigated with respect to survival to find the possible effects of age, gravida, parity, menstruel condition, pre-operative Ca-125, treatment period, cytologic washings, presence of ascites, tumor histology, stage and grade, maximal tumor diameter, adjuvan chemotherapy and cytoreductive success. Also 55 ovarian carcinoma patients were investigated with respect to prognostic factors for early 2-year survival. Results: The two-year survival ratewas 69% and the 5-year survival rate was 25.5% for the whole study population. Significant factors for 2-year survival were preoperative CA-125 level, malignant cytology and FIGO clinical stage. Significant factors for 5-year survival were age, preoperative CA-125 level, residual tumor, lymph node metastases, histologic type of tumor, malignant cytology and FIGO clinical stage. Logistic regression revealed that independent prognostic factors of 5-year survival were patient age, lymph node metastasis and malignant cytology. Conclusions: We consider quality registries with prospectively collected data to be one important tool in monitoring treatment effects in population-based cancer research.     

329例转移性乳腺癌的预后因素及生存分析

目的观察转移性乳腺癌患者的疗效及预后情况,分析影响转移性乳腺癌患者生存的预后因素。方法选取转移性乳腺癌患者329例进行回顾性研究。结果总生存率(OS)1年总生存率为62.9%,2年总生存率为41.9%,3年总生存率为25.8%及5年总生存率11.9%。接受治疗的患者中位生存时间为18.2个月,分别为:骨转移患者23.4个月,淋巴结转移患者31.3个月,肝转移患者17.6个月,肺转移患者15.3个月,脑转移患者7.2个月。通过单因素及多因素分析,获取了同生存获益相关的预后因素。结论对转移性乳腺癌生存有积极影响的独立因素包括:体力状况,年龄≤70岁以及没有内脏的转移。对于此类患者,在解救治疗中应采取较为积极的处理措施,争取更好的生存获益。     

93例转移性恶性黑色素瘤预后分析

目的:探讨转移性恶性黑色素瘤的预后因素。方法:回顾性分析93例经病理证实的转移性恶性黑色素瘤患者的临床资料及实验室、影像学检查结果。结果:93例转移性恶性黑色素瘤患者2年生存率为10.8%(10/93)。性别、体质状况、有无肝脏转移、转移部位数目、血清LDH水平、白蛋白水平以及转移灶是否切除对患者的2年生存率有显著影响;而不同年龄患者的2年生存率无统计学差异。结论:女性、体质状况较好、无肝脏转移、单一部位转移、LDH或白蛋白水平正常以及孤立转移病灶的手术切除是预后好的指标。     

Improvement of Survival Over Time for Colon Cancer Patients by Anatomical Sub-sites

The aims of this study are to describe and to evaluate improvement of survival over time for colon cancer patients by anatomical sub-sites. Data on 661 patients newly diagnosed as having colon cancer at Osaka Medical Center for Cancer and Cardiovascular Diseases from 1978 to 1991 were examined in this study. Corrected survival was calculated with the Kaplan-Meier method according to the period of diagnosis: early period (1978-84) and later period (1985-91). Factors concerning the difference in survival between the two periods were examined with the Cox proportional hazards regression model according to sub-site. Five-year corrected survival of the patients with left colon cancer improved significantly (60 to 72%; P <0.01), probably due to advances in treatment, while that of patients with transverse colon cancer also improved significantly (39 to 67%; P <0.01), mainly because of progress in diagnosis. The five-year corrected survival of those with right colon cancer did not increase (57 to 46%; P =0.14), owing to lack of improvement in stage at diagnosis. Among the three sub-sites, the right showed the worst five-year survival in the later period. We concluded that survival of patients with right colon cancer, differing from the other anatomical sub-sites, did not improve, possibly because of lack of symptoms. The screening programs for colon cancer introduced in Japan in 1992 may be expected to improve the survival of patients with colon cancer, including that of the right colon.