结肠癌根治术后复发的多因素分析

目的探讨结肠癌根治术后复发的因素。方法对2000年1月～2005年1月收治的135例结肠癌患者的临床资料进行回顾性分析。选择对结肠癌术后复发可能产生影响的临床因素,通过Cox比例风险模型进行多因素分析。结果全组患者复发率为16.3％。单因素分析显示,淋巴结转移、肿瘤大小、Dukes’分期和肿瘤细胞分化程度与结肠癌根治术后肿瘤复发有关。多因素分析显示,淋巴结转移和肿瘤细胞分化程度与结肠癌根治术后肿瘤复发有关。结论淋巴结转移和肿瘤细胞分化程度是影响结肠癌术后复发的独立危险因素。     

腹腔镜直肠癌手术中肠系膜下动脉根部淋巴结转移的危险因素分析

目的:探讨腹腔镜直肠癌术中肠系膜下动脉根部淋巴结(No.253淋巴结)的临床病理特点、转移的危险因素及其对患者预后的影响。方法:回顾分析2017年1月至2018年12月行腹腔镜直肠癌手术的432例患者的临床病理资料，并对肠系膜下动脉根部淋巴结转移的影响因素进行单因素与多因素分析。术后随访，进行3年总生存率与无病生存率的log-rank检验分析。结果:肠系膜下动脉根部淋巴结转移率为6.48%(28/432),No.253淋巴结阳性病例均有癌旁淋巴结转移。肠系膜下动脉根部转移患者的3年总生存率(57.14%vs. 86.38%,P<0.001)、3年无病生存率(50.00%vs. 81.43%,P<0.001)均低于无转移的患者。单因素分析显示，肿瘤距肛缘>7 cm(P=0.021)、CEA>5 ng/mL(P=0.006)、肿瘤直径>5 cm(P=0.039)、T₃～T₄分期(P=0.030)、低分化(P=0.026)、非管状腺癌(P=0.005)是No.253淋巴结转移的危险因素。Logistic多因素分析进一步...     

结肠癌根治术后早期复发转移的相关因素分析及治疗

目的：探讨结肠癌术后复发转移的相关因素及治疗。方法：回顾分析1998年1月—2005年12月收治的54例行结肠癌根治术后复发转移患者的临床病理资料。结果：单因素分析显示,年龄、性别、肿瘤大体分型、肿瘤部位、浸润深度、淋巴转移、Dukes分期、手术及术后是否化疗与早期复发转移相关（P〈0.05）;多因素分析发现,年龄、Dukes分期、分化程度、肿瘤组织类型、淋巴结转移、术后化疗是影响结肠癌根治术后早期复发转移的重要因素（P〈0.05）。结论：年龄、组织学类型、分化程度、肿瘤分期、淋巴结转移及术后化疗是影响结肠癌术后早期复发的重要危险因素;对于复发转移的结肠癌患者,再次手术联合术后化疗能获得良好效果。     

手术切除直肠癌患者预后危险因素分析

目的探讨手术切除直肠癌患者预后的相关危险因素。方法回顾性分析286例直肠癌术后患者的临床资料,对比不同因素患者的5年生存率。结果单因素分析显示,不同性别、年龄患者5年生存率比较无统计学差异(P0.05),而不同病程、术前CEA水平、手术方式、肿瘤分化程度、肿瘤大小、肿瘤浸润深度、淋巴结转移个数、肿瘤临床分期患者的5年生存率比较差异具有统计学意义(P0.05);Logistic回归分析显示,术前CEA水平、肿瘤分化程度、淋巴结转移、肿瘤浸润深度以及肿瘤临床分期均为直肠癌术后患者预后不良的独立危险因素(P0.05)。结论术前CEA水平、肿瘤分化程度、淋巴结转移、肿瘤浸润深度以及肿瘤临床分期均为直肠癌术后患者预后不良的独立危险因素。因此,直肠癌的早期诊断及早期手术治疗对于改善患者预后、提高患者生活质量将具有重要意义。     

结肠癌完整结肠系膜切除术临床分析

目的探讨和评价完整结肠系膜切除术(CME)治疗结肠癌的疗效。方法将60例结肠癌患者按自愿原则分为实验组和对照组两组,每组30例。对照组行传统结肠癌根治术,实验组实施完整结肠系膜切除术。观察两组手术平均出血量、拔管时间、肛门排气时间、总淋巴结及阳性淋巴结清扫数、住院天数、进食时间及术后随访情况。结果实验组总淋巴结及阳性淋巴结清扫数量多于对照组。手术平均出血量少于对照组,肛门排气时间、拔管时间、住院时间均短于对照组,两组比较,差异均有统计学意义(P0.05)。两组均获随访12个月,其中实验组术后出现2例(6.67%)吻合口漏,1例(3.33%)肿瘤复发,无死亡病例。对照组术后出现4例(13.33%)吻合口漏、3例(10%)肿瘤复发,死亡2例(6.67%),两组比较差异有统计学意义(P0.05)。结论完整结肠系膜切除术治疗结肠癌疗效好,患者不良反应少,具有临床推广价值。     

结直肠癌肝转移的外科治疗

目的探讨结直肠癌肝转移的外科手术适应证和疗效,以及临床病理因素对其预后的影响。方法回顾性分析1991年1月至2000年12月间施行肝切除术的61例结直肠癌肝转移患者的临床资料。结果结直肠癌肝转移切除术后1、3、5年生存率分别为72.1%、58.1%和26.0%,术后出现并发症8例,20例肝转移灶有假包膜形成。结直肠癌Dukes分期、病理类型、转移灶数目、假包膜形成对术后生存率有影响(P<0.05)。术后综合治疗者3年生存率明显优于无综合治疗者(P<0.05)。肝转移灶大小及其切除时间并不影响患者预后(P>0.05)。结论临床病理分期早、肿瘤分化程度高、转移灶数目不超过3个、肿瘤假包膜形成及术后综合治疗预示结直肠癌肝转移切除患者有较好的预后。     

术前外周血中性粒细胞/淋巴细胞比值对高龄结肠癌患者预后的评估价值

目的:探讨术前外周血中性粒细胞/淋巴细胞比值(NLR)对高龄(≥75岁)结肠癌患者根治术后的预后评估价值。方法:收集2008年1月—2013年1月间在辽河油田总医院普通外科接受根治性手术的67例75岁以上结肠癌患者的临床资料,分析患者术前外周血NLR与临床病理因素及生存率的关系。结果:根据NLR的ROC曲线截点值(2.98)将患者分为低NLR组(NLR3)和高NLR组(NLR≥3),其中低NLR组44例,高NLR组23例。与低NLR组比较,高NLR组肿瘤分化程度低(P=0.040)、淋巴结转移率高(P=0.018)、TNM分期高(P=0.008)、CEA水平高(P=0.026);全组患者术后3年总生存率为62.7%,其中低NLR组和高NLR组术后3年生存率分别为72.7%和43.5%,两组差异有统计学意义(P0.05)。单因素分析显示,术前NLR连同肿瘤分化程度、肿瘤分期、淋巴结转移和CEA水平与患者术后生存有关(均P0.05)。结论:术前NLR对高龄结肠癌患者根治术后的预后判断有一定价值,高NLR者预后较差。     

腹腔镜右半结肠癌全结肠系膜切除术的安全性与可行性分析

目的:探讨腹腔镜右半结肠癌全结肠系膜切除术的安全性与可行性。方法:将90例右半结肠癌患者按手术方法分为腹腔镜组与开腹组,观察两组患者术中、术后相关指标,探讨两种术式的近期疗效及肿瘤根治性。结果:两组手术时间、术中出血量、淋巴结清扫数量差异无统计学意义(P>0.05);腹腔镜组术后下床活动时间、排气时间、住院时间及术后并发症发生率明显优于开腹组,差异有统计学意义(P<0.05);两组术后1年、3年生存率及局部复发率、远处转移率差异均无统计学意义(P>0.05)。结论:腹腔镜全结肠系膜切除术具有疗效满意、术后康复快等优点,在掌握手术适应证、手术原则、手术技巧的前提下,腹腔镜辅助全右半结肠系膜切除术是安全、有效、可行的,对促进患者术后康复、提高近期生存率具有积极意义。     

左半结肠癌与右半结肠癌的临床特征及预后影响因素分析

目的探讨左、右半结肠癌的临床特征及影响患者长期预后的危险因素。方法纳入180例腹腔镜结肠癌根治术患者作为研究对象,根据肿瘤部位不同分为左半结肠癌组(LCC,98例)和右半结肠癌组(RCC,82例),比较两组病例基本资料和临床病理特点,随访5年观察两组术后生存情况,采用Logistic多因素分析探讨影响患者术后5年生存率的危险因素。结果两组患者在性别、首发症状、肿瘤分期、分化程度水平方面差异均有统计学意义(均P0.05),LCC组术后5年生存率为89.80%(88/98),RCC组为78.05%(64/82),两组差异有统计学意义(Log-rankχ~2=6.228,P=0.013)。多因素分析结果显示肿瘤分期、分化程度、淋巴结转移及术后化疗是影响患者预后的独立因素(OR=2.184、1.881、2.255、1.984,95%CI=1.231~28.579、2.756~30.195、1.367~10.084、1.692~9.131,P=0.000、0.000、0.002、0.000),肿瘤位置不是独立危险因素(OR=1.655,95%CI=0.452~7.138,P=0.137)。结论左、右半结肠癌具有不同的临床疾病特征和病理特点,RCC较LCC预后更差。     

完整结肠系膜切除术治疗右半结肠癌的临床效果

目的观察完整结肠系膜切除术治疗右半结肠癌的临床效果。方法将58例右半结肠癌患者随机分为2组,各29例。对照组行传统结肠癌根治术,观察组采用完整结肠系膜切除术,比较2组的治疗效果。结果 2组手术时间、术中出血量、术后肛门排气时间、并发症发生率及住院时间比较,差异无统计学意义(P0.05)。观察组淋巴结清扫数目优于对照组,差异有统计学意义(P0.05)。术后2 a观察组的肿瘤复发率及患者存活率优于对照组,但组间差异无统计学意义(P0.05)。结论与传统结肠癌根治术相比,完整结肠系膜切除术治疗右半结肠癌,可最大限度清扫淋巴结,而且未明显增加手术风险及并发症发生率,有利于改善患者的预后。     

脉管癌栓浸润对II期结肠癌患者预后影响分析

目的:探讨Ⅱ期结肠癌患者脉管癌栓浸润的影响因素及其与预后的关系。方法:收集2007年1月—2010年8月中国医科大学附属第四医院行结肠癌根治术的152例Ⅱ期结肠癌患者临床病理资料,分析患者的脉管癌栓浸润与临床病理指标的关系,以及预后影响因素。结果:全组患者5年总生存率为73.7%,其中Ⅱa、Ⅱb、Ⅱc期患者分别为79.6%、73.3%、65.8%。统计学分析显示,脉管癌栓浸润与结肠癌肿瘤部位、分化程度和T分期明显有关(均P0.05)。单因素分析显示,分化程度、切缘阳性、脉管癌栓浸润、淋巴结检出个数及T分期是结肠癌患者预后的影响因素(均P0.05);多因素分析显示,T分期、切缘阳性和脉管癌栓浸润是影响生存的独立预后因素(均P0.05)。脉管癌栓浸润阳性的患者5年生存率明显低于阴性的患者(52.7%vs.85.6%,P0.05),并且脉管癌栓浸润阳性患者中化疗患者5年生存率高于非化疗患者(60.7%vs.44.4%,P0.05)。结论:Ⅱ期结肠癌患脉管癌栓浸润与肿瘤部位、分化程度、T分期有关,是影响Ⅱ期结肠癌患者预后的独立危险因素,对脉管癌栓浸润阳性的Ⅱ期结肠癌患者建议给予辅助化疗。     

Lymph Node Recovery from Colorectal Tumor Specimens:Recommendation for a Minimum Number of Lymph Nodes to be Examined

Lymph node involvement is the mostimportant prognostic factor for patients who have undergone radicalsurgery for colorectal carcinoma. An accurate examination of thesurgical specimens is mandatory for the correct assessment of the lymphnode status of the tumor. The risk of understaging is particularly highfor patients with tumors classified as Dukes B (TNM stage II). The aimof this study was to determine if a specified minimum number of lymphnodes examined per surgical specimen could have any effect on theprognosis of patients who had undergone radical surgery for Dukes Bcolorectal cancer. Between 1988 and 1995 a total of 140 patientsunderwent radical resection of Dukes B colorectal cancer by the samesurgeon (C.C.). The relation between clinicopathologic variables andsurvival was estimated using the Kaplan-Meier method. The Coxproportional hazard regression model was used to identify the variablesthat can independently influence survival. A median of 12 lymph nodes(range 3–38) was examined per tumor specimen. The 5-year survival rateof Dukes B patients who had had eight or fewer lymph nodes examinedafter surgery was 54.9%, whereas the survival rate for those who hadhad nine or more lymph nodes examined was 79.9% (p < 0.001). Cox regression analysis identified the number of lymph nodes asthe only independent prognostic factor (p = 0.01).Seventy patients with one to four metastatic lymph nodes (Dukes Cpatients) who had been operated on during the same period were includedin the survival analysis for comparison. The 5-year survival rate ofthe Dukes B patients with eight or fewer lymph nodes examined wassimilar to that of the 70 Dukes C patients (54.9% and 51.8%,respectively). Examination of eight or fewer lymph nodes in Dukes Bcolorectal patients may be considered a high risk factor for missingpositive lymph nodes in the surgical specimens. Our results suggestthat harvesting and examining a minimum of nine lymph nodes persurgical specimen may be sufficient for reliable staging of lymphnode-negative tumors.     

XPD 751基因单核苷酸多态性与结肠癌术后mFOLFOX6化疗疗效及预后的关系

目的探讨DNA修复基因XPD 751位点单核苷酸多态性与结肠癌术后mFOLFOX6化疗疗效及预后的关系。 方法前瞻性选择2013年6月至2015年6月乐山市人民医院接受根治性手术的105例结肠癌患者作为结肠癌组,另选择同期100名健康者作为对照组。DNA测序技术检测XPD 751位点单核苷酸多态性以及基因型频率,mFOLFOX6方案化疗6个月后对患者进行疗效评价,Kaplan-Meier法和Cox多因素回归分析XPD 751位点基因位点多态性与预后的关系。 结果结肠癌组中XPD 751 AA基因型患者的疾病控制率（DCR）为86.44%（51/59）,显著高于CA/CC基因型的65.22%（30/46）（χ²=6.603,P<0.05）。105例患者3年总生存率、无病生存率分别为69.52%、29.52%,其中AA基因型分别为77.97％、47.46%,高于CA/CC基因型的58.70%、6.52%,差异有统计学意义（χ²=4.712、20.817,P=0.030、<0.01）,复发转移患者的AA基因型分布频率明显低于CA/CC基因型（30.51% vs 52.17%,χ²=5.055,P=0.025）。TNM分期和XPD 751 CA/CC基因型是影响结肠癌患者总体生存情况的危险因素（P=0.008、0.017）。 结论XPD 751位点CA/CC基因型结肠癌患者根治性术后mFOLFOX6化疗的敏感性差,无病生存率和总生存率较低,检测XPD 751位点基因多态性有助于评估结肠癌患者化疗疗效和预后。     

腹腔镜结直肠癌根治术不同术中转开腹时机及3年生存期分析

目的分析腹腔镜结直肠癌根治术不同术中转开腹时机对患者安全性及3年生存期的影响。方法回顾性队列研究2015年1月至2017年1月实施结直肠癌根治术的75例结直肠癌患者临床资料,将腹腔镜术切皮后1 h内中转开腹的43例患者纳入早期组,将切皮后1 h后中转开腹的32例患者纳入延迟组。采用SPSS23.0软件进行处理,围术期各项相关指标、肠道功能以(±s)表示,独立t检验;并发症、生存率用百分比表示,用χ²检验或Fisher精确检验,采用Kaplan-meier计算生存率,P<0.05为差异有统计学意义。结果早期组手术时间、术后首次排便及排气时间、术后住院时间、术中出血量均少于延迟组(P<0.05);术后3个月MSKCC评分早期组各项评分均比延迟组高(P<0.05);早期组术后并发症发生率(7.0%)较延迟组(25.0%)低(P<0.05);早期组术后1、2、3年生存率(100.0%、88.4%、72.1%)与延迟组(93.8%、81.3%、62.5%)比差异无统计学意义(P>0.05)。结论腹腔镜术切皮后1 h内中转开腹手术可促进直肠癌根治术患者术后肠道功能恢复,减少术后并发症,加快术后康复进程,近期疗效及安全性较高。     

老年患者结肠癌手术治疗中完整结肠系膜切除术的安全性及可行性

目的 探讨老年结肠癌患者手术中实施完全切除完整结肠系膜的安全性及可行性.方法 选取2018年3月至2020年3月新泰市第二人民医院收治的结肠癌手术老年患者74例,使用双盲法随机分为干预组和对照组,每组各37例.干预组手术方式为完整结肠系膜切除术,对照组手术方式为传统结肠切除术,比较两组患者并发症发生率、结肠癌复发率、淋...     

Nerve-sparing Surgery for Advanced Rectal Cancer Patients: Special Reference to Dukes C Patients

Several nerve-sparing operations for advanced rectal cancer that aim to preserve genitourinary function without compromising tumor clearance have been developed in Japan. The aim of this study was to evaluate the survival and local recurrence of these procedures in Dukes B and C patients. A total of 177 patients with advanced rectal cancer underwent curative nerve-sparing surgery (NSS) over the last 11 years; 52 were Dukes B patients and 54 were Dukes C. Altogether 36 had Dukes C1 and 18 had Dukes C2 tumors, 13 with lateral lymph node metastases, designated lateral LN(+). The 5-year survival rate was 92% for Dukes B, 67% for Dukes C1, and 39% for Dukes C2 patients: 11% for Dukes C2 patients with lateral LN(+). The local recurrence rate was 6% for Dukes B, 11% for Dukes C1, and 33% for Dukes C2 patients: 20% for the lateral LN(−) group and 39% for the lateral LN(+) group. Almost all of the patients undergoing NSS could micturate spontaneously, but preservation of sexual function was not as successful. Although there is no guarantee of preserving satisfactory sexual function, our NSS is an acceptable procedure for Dukes B, C1, and C2 patients without lateral lymph node metastases.     

Interpretation of the Randomized EVAR Trials

Purpose : Laparoscopic surgery for colon cancer has been proven safe, but controversy continues over implementation of laparoscopic technique for rectal cancer. The aim of this study was to compare the long-term outcomes of laparoscopically assisted and open surgery for nonmetastatic colorectal cancer.

Material and methods : From January 2001 to December 2006 all patients with nonmetastatic adenocarcinoma of the colon and rectum were considered for inclusion in this prospective non-randomised trial. The primary endpoint was overall survival, disease free survival and recurrence rate. Analysis was by intention to treat.

Results : A total of 365 resections were performed for nonmetastatic adenocarcinoma of the colon and rectum during the study period. Of those resections, 220 were colonic and 145 were rectal. In the patients with colon cancer 119 (54.1%) were operated laparoscopically and 101 (45.9%) by open surgery, in the patients with rectal cancer 75 (51.7%) were treated by laparoscopy and 70 (48.3%) by open technique. No statistically significant difference was found between the laparoscopic and open group regarding 5-year overall survival (p = 0.17 for colon cancer, p = 0.60 for rectal cancer), 5-year disease free survival (p = 0.25 for colon cancer, p = 0.81 for rectal cancer) and overall recurrence (p = 0.78 for colon cancer, p = 0.79 for rectal cancer). With respect to the tumor stage, in rectal cancer the probability of 5-year disease free survival was significantly higher in the laparoscopic group in stage III (p = 0.03).

Conclusion : Laparoscopic surgery for colorectal cancer is an oncologically safe procedure that is associated with a survival and recurrence rate equal to open surgery.     

Résection cœlioscopique du côlon pour adénocarcinome. Présentation d'une série de 218 cas

Study aimThe aim of this retrospective study was to report the results of a series of 218 laparoscopic resections for adenocarcinoma of the colon by the same surgical team over a 6-year period.Patients and methodsLaparoscopic procedures included, for the right and the left colon, at first a ligature of the vascular pedicles, secondarily a dissection of the mesocolons, and were almost identical to the conventional procedures. A conversion to open laparotomy was necessary in 8.3% of the patients. Among 218 patients, there were 117 men and 101 women; the mean age was 69 years. Twenty nine per cent of the patients had already undergone open laparotomy. Mean ASA grade was 2.1. An emergency operation was necessary for 9% of the patients in relation with colonic obstruction (n = 20) or peritonitis (n = 3).ResultsColonic resections were considered curative in 180 patients (82.6%). The mean duration of surgery was 157 minutes for the right colectomies and 148 for the left. The proportion of A, B, C, D Dukes stage tumours was respectively 19.3%, 38.5%, 27.5% and 14.7%. There was one post-operative death related to a serious epileptic seizure due to unknown cerebral métastases. The morbidity rate was 5.5% and the early reintervention rate 2.8%. There was no lost to follow-up. With a mean 35-month follow-up. 82.2% of the patients were alive after curative surgery. Abdominal wall recurrence at port sites occurred in four patients operated on for a Dukes C cancer before 1994. Prognosis was significantly dependant on cellular differentiation, lymph node extension, pericolic extension and Dukes stage. The 5-year actuarial survival rate, according to Kaplan-Meier method was 65.36%.ConclusionLaparoscopic colon cancer resection was used by the authors in 92% of patients during 1997. The conversion rate to open laparotomy has been lower than 5% since 1995. Post-operative mortality was 0.4% and post-operative morbidity 5.5%. After curative colonic cancer resection, the 5-year actuarial survival rate was 65%.     

腹腔镜根治术在结肠单发腺癌治疗中的应用

目的对比分析腹腔镜根治术与开腹根治术治疗结肠单发腺癌时,在安全性、术后并发症及临床疗效等方面存在的差异性。 方法选择2008年4月至2011年4月接受手术治疗的198例结肠单发腺癌患者。采用随机抽样的方法将其分为开腹组和腹腔镜组,每组99例。开腹组患者采取传统的开腹手术,切掉癌变的结肠部分;腹腔镜组患者采取腹腔镜根治术,在腹腔镜的配合下实施癌变结肠部分的切除手术。对两组患者术中和术后的一些相关指标、术后并发症、术后生活质量以及近远期术后的生存率等数据进行统计分析。 结果腹腔镜组平均手术时间、术中出血量、术后肠功能恢复时间、术后排气时间、住院时间均低于开腹组（t=11.182、22.960、6.420、8.635、16.850,均P<0.01）;开腹组术后并发症发生率高于腹腔镜组,差异有统计学意义（17.2% vs 2.0%,χ²=13.100,P=0.000）。腹腔镜组术后5周时的总体生活质量评分优于开腹组（P<0.01）。对于Ⅱ期结肠癌患者,腹腔镜组的术后5年总体生存率要优于开腹组。 结论患者接受腹腔镜手术来治疗结肠单发腺癌的安全性以及临床疗效均优于开腹手术,且接受腹腔镜手术治疗的患者术后并发症发生率优于开腹手术。     

右半结肠癌No.206组淋巴结转移的观察研究

目的:分析右半结肠癌No.206组淋巴结转移的规律,为淋巴结的清扫提供临床参考。方法:回顾性收集2015年1月至2019年12月完成的111例右半结肠癌根治术患者的临床资料。观察指标:人口学特征、手术与术后恢复情况、术后病理学检查、随访及生存情况。结果:111例患者中男59例,女52例,中位年龄60岁。肿瘤部位回盲部9例,升结肠37例,结肠肝曲62例,横结肠右侧3例。患者均顺利完成右半结肠癌根治术,其中腹腔镜手术79例,开放手术8例,达芬奇手术24例;腹腔镜手术中1例中转开腹。手术时间110(98,115)min,术中出血量30(20,50)mL,术后肛门排便时间4(3,5)d,术后住院7(6,8)d。术后总并发症发生率9.9%(11/111),其中切口感染、脂肪液化5例,乳糜瘘5例,吻合口出血1例。病理标本肿瘤TNM分期Ⅰ期17例、Ⅱ期44例、Ⅲ期49例、Ⅳ期1例。淋巴结检出27(23,31)枚,阳性淋巴结检出0(0,2)枚,淋巴结转移率为44.14%(49/111)。No.206组淋巴结检出数为3(1,4)枚,阳性淋巴结检出数为0(0,0)枚,淋巴结转移率为0.9%(1/111)。术后102例(91.9%)获得随访,9例失访,随访7~65个月,中位随访时间23个月。5年总生存率86.3%,5年无病生存率73.4%。结论:右半结肠癌No.206组淋巴结转移率较低,如果术前或术中评估怀疑No.206组淋巴结转移或局部进展期肝曲结肠癌,建议清扫No.206组淋巴结。