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目的分析患者预后营养指数(PNI)与中低位直肠癌行预防性末端回肠造瘘指征的关系。方法将扬州市第一人民医院普外科2005年12月至2015年12月收治的中低位直肠癌患者378例作为研究对象。PNI值计算公式为PNI=血清白蛋白值(g/L)+5×外周血淋巴细胞总数(×109/L),分析患者临床病理特征与PNI的关系;并将研究对象分为高PNI组及低PNI组,其中高PNI组203例,低PNI组175例,比较两组吻合口瘘发生率;将低PNI组患者按照是否行预防性造瘘,分为造瘘组及未造瘘组,其中造瘘组106例,未造瘘组69例,分析两组患者吻合口瘘发生率及短期并发症发生率。结果确定高PNI组及低PNI组的分界值为43,年龄65岁、肿瘤高中分化的中低位直肠癌患者PNI值均显著高于年龄≥65岁及肿瘤低分化的患者(P0.05);高PNI组吻合口瘘发生率明显低于低PNI组(P0.05);低PNI组患者中造瘘组吻合口瘘发生率、短期并发症发生率均明显低于未造瘘组(P0.05)。结论预后营养指数是较好的术前预测病情、手术风险及预后的指标。低PNI是中低位直肠癌发生吻合口瘘的危险因素之一,对低PNI的中低位直肠癌患者行预防性造瘘可降低吻合口瘘的发生率,并降低吻合口瘘的严重程度。 相似文献
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[目的]探讨272例食管贲门癌术后吻合口瘘发生的原因及减少其发生的措施。[方法]回顾分析近年经治的272例食管贲门癌术后发生吻合口瘘的病人术前状态 ,围术期处理及手术方式 ,探讨相关因素。[结果]全组272例食管贲门癌手术后并发生吻合口瘘15例(发生率5 5%) ,其中颈部吻合口瘘6例 ,胸部吻合口瘘9例 ,死亡2例(瘘死亡率13 3 %)。患者营养状态及手术操作与吻合口瘘发生密切相关。[结论]重视手术操作规范技巧 ,合理的围手术期处理是预防食管贲门癌术后发生吻合口瘘的关键所在。 相似文献
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目的 研究食管胃结合部腺癌术后患者预后的相关因素.方法 入选食管胃结合部腺癌患者173例,从手术结束开始随访5年为研究终点,统计患者的1、3、5年生存率和中位生存时间.分析年龄、性别、淋巴结转移、是否化疗、HER-2表达与否等因素与该病的相关性.结果 经过5年随访,食管胃结合部腺癌患者在1、3、5年的生存率分别为87.9%、48.6%、44.5%,中位生存期为38.0月.分别统计和分析患者的各项因素,其中性别(P=0.000)、年龄(P=0.012)、TNM分期(P=0.000)、淋巴结转移(P =0.000)、化疗(P=0.000)、HER-2表达(P=0.000)等因素的差异均具有统计学意义.结论 食管胃结合部腺癌患者术后生存期与性别、年龄、TNM分期、淋巴结转移、是否化疗、HER-2表达均有不同程度的关联,值得进一步研究. 相似文献
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摘 要:[目的] 探讨食管胃结合部腺癌患者术后1年内复发与死亡的相关危险因素。[方法] 回顾性分析了2006年3月至2007年2月在河北医科大学第四医院胸外科诊治的387例食管胃结合部腺癌患者的临床病例资料。[结果] 全组患者1年生存率为79.0%,5年生存率为28.7%,术后1年内复发死亡的患者71例,术后5年以上未复发的患者为109例。单因素分析显示:性别、肿瘤最大直径、肿瘤浸润深度、淋巴结转移及残端是否阳性是影响预后的因素。多因素分析显示:性别(P=0.037)、肿瘤最大直径(P=0.030)、淋巴结转移(P=0.000)是影响预后的独立危险因素。[结论] 食管胃结合部腺癌的预后仍较差,复发转移依然是主要的致死原因。而性别、肿瘤最大直径和淋巴结转移是预测术后早期复发转移的独立危险因素。 相似文献
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目的评价食管癌切除术行食管胃单层宽边连续吻合的临床效果。方法将符合手术条件的936例食管癌患者随机分为试验组和对照组,每组468例,均行手术治疗,试验组行食管胃单层宽边连续吻合,对照组行食管胃丝线间断缝合。结果试验组无手术死亡,术后发生吻合口瘘1例(0.2%),吻合口狭窄1例(0.2%),其他并发症17例。对照组围手术期死亡1例,术后发生吻合口瘘8例(1.9%),吻合口狭窄11例(2.4%),其他并发症24例。两组间术后吻合口瘘、吻合口狭窄发生率差异有统计学意义(P值分别为0.019和0.004),而其他并发症的发生率差异无统计学意义(P=0.264)。结论食管胃单层宽边连续吻合方法简便,可有效预防食管胃吻合口瘘和吻合口狭窄的发生。 相似文献
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摘 要:[目的] 探讨腹腔镜经食管裂孔(transhiatal esophagectomy,TH)法治疗SiewertⅡ型进展期食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)的手术方式及其临床疗效。[方法] 回顾性分析接受腹腔镜TH法行全胃根治性手术治疗的31例进展期AEG患者资料。[结果] 术中食管显露长度为9.5±1.6cm;淋巴结清扫总数45±19枚,其中下纵隔淋巴结清扫数为4±2枚;30例患者行R0切除;共6 例患者发生并发症,无吻合口瘘;术后住院时间11.3±2.1d。全组患者3年生存率58.1%。多因素分析提示T分期是影响患者预后的独立危险因素(HR=5.124)。[结论] 腹腔镜TH法治疗SiewertⅡ型进展期AEG具有较好的临床疗效,是一种安全可行的手术方式。 相似文献
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直肠癌前切除术后吻合口瘘的危险因素及治疗方法分析 总被引:2,自引:0,他引:2
[目的]探讨直肠癌前切除术后发生吻合口瘘的高危因素及其处理方法。[方法]回顾性分析自1999年1月至2008年7月1677例行直肠癌前切除术患者的临床资料及发生吻合口瘘后的治疗措施。[结果]共有44例患者(2.6%)术后发生吻合口瘘,其诊断发生吻合口瘘的中位时间为术后第6d。单因素分析显示,男性、肿瘤下缘距肛门小于7cm、术前肠道梗阻为术后吻合口瘘的独立危险因素。出现吻合口瘘后,有9例患者采取了保守治疗,19例患者立刻采取了积极手术治疗,另有16例患者在保守治疗无明显疗效后采取了手术治疗。[结论]男性、肿瘤下缘距肛门小于7cm、术前肠道梗阻的直肠癌前切除术患者易出现吻合口瘘,治疗方式应根据病人临床状况选择。 相似文献
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目的:明确基于系统性炎症评分和营养状况对食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)患者术后预后的影响。方法:回顾性收集2010年03月至2019年03月我院451例AEG手术患者的临床资料,以及炎症-营养标志物(NLR、LMR、AGR、ALI、mGPS和PNI)。根据受试者工作特征(ROC)曲线获取截断值并分组,NLR、LMR、AGR、ALI和 PNI的截断值分别为3.76、3.01、1.30、27.55、42.68;COX模型分析患者预后的影响因素;采用Kaplan-Meier方法绘制生存曲线,Log-Rank检验比较组间生存差异。结果:患者无疾病生存期(DFS)与肿瘤分化程度、肿瘤大小、脉管癌栓、T分期、N分期、pTNM分期、血红蛋白、NLR、PNI、LMR、ALI相关(P<0.05),总生存期(OS)与肿瘤分化程度、肿瘤大小、脉管癌栓、T分期、N分期、pTNM分期、NLR、AGR、PNI、LMR、ALI相关(P<0.05)。在多因素分析中,脉管癌栓、pTNM分期、ALI是DFS的独立影响因素,而LMR、PNI、pTNM分期则是OS的独立影响因素。Kaplan-Meier生存曲线显示,PNI<42.68, LMR<3.01及ALI<27.55患者的DFS和OS均更短(P<0.05)。结论:炎症反应和营养状况与术后AEG患者临床病理因素及预后相关,ALI是AEG患者无疾病生存期的独立影响因素;PNI及LMR是AEG患者总生存期的独立影响因素。 相似文献
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Juan Li Shiwen Mei Sichen Zhou Fuqiang Zhao Qian Liu 《Journal of gastrointestinal oncology.》2022,13(2):710
BackgroundPerineural invasion (PNI) is considered a risk factor of survival but does not yet inform treatment decisions, and has not been studied separately in stage II colorectal cancer (CRC) patients whose postoperative traditional chemotherapy is controversial. This cohort study aimed to assess the association of PNI with basic clinicopathological features and patient outcomes after curative resection and the effects of PNI on responses to adjuvant chemotherapy in stage II CRC.MethodsThe clinical data of 371 stage II CRC patients who underwent curative-intent surgery at the National Cancer Center/Cancer Hospital in 2014 were retrospectively reviewed. The adjuvant chemotherapy data were acquired from follow-up information. PNI status was examined, and the overall survival (OS) and disease-free survival (DFS) rates were analyzed.ResultsPNI was detected in 82 of the 371 patients (22.1%) and was closely correlated with preoperative serum carcinoembryonic antigen (CEA) levels (P=0.030), gross tumor type (P=0.010), tumor differentiation (P=0.010), p stage (P<0.001), and extramural vascular invasion (EMVI) (P<0.001). The median follow-up time was 71 months. The 5-year OS was 84.1% and 96.5% (P<0.001), and the 5-year DFS was 75.6% and 91.3% (P<0.001) for PNI-positive (+) and PNI-negative (−) patients, respectively. The multivariate regression analyses identified PNI as an independent negative prognostic factor for DFS [hazard ratio (HR): 2.95; 95% confidence interval (CI), 1.546–5.626; P=0.001] and OS (HR: 3.966; 95% CI, 1.642–9.575; P=0.002). Among PNI (+) patients, DFS and OS were positively correlated with CEA levels (P=0.005 and P=0.004, respectively). Postoperative chemotherapy failed to improve DFS (P=0.480 and P=0.267, respectively) and OS (P=0.940 and P=0.077, respectively) regardless of whether the patients were PNI positive or not.ConclusionsIn stage II CRC patients, PNI was a poor independent predictor for DFS and OS. Among PNI (+) patients, CEA levels were positively correlated with DFS and OS. Traditional postoperative adjuvant chemotherapy does not improve outcomes of PNI (+) patients. Therefore, as to the active role of PNI and vacancy for treatment in allusion to PNI, follow-up of PNI (+) patients with elevated CEA level should be strengthened and further research on drug conducted on PNI deserve to be carried on. 相似文献
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目的:探讨术前预后营养指数(prognostic nutritional index,PNI)在肝内胆管癌根治性切除术后的预后预测价值。方法:回顾性分析2012年1月至2018年12月于我院普通外科因肝内胆管癌行根治性切除术的107例患者的临床病理资料,分析PNI与患者临床病理特征、预后预测价值及其与预后的关系。结果:术前低PNI组与高PNI组患者的临床病理特征分析显示:低PNI组患者中CEA>5.0 ng/mL、CA19-9>39.0 U/mL、Child-Pugh肝功分级呈B级、肿瘤大小>5 cm、T分期呈T3及T4期、N1期比例明显高于高PNI组患者(P<0.05)。单因素分析显示,PNI是影响患者预后的危险因素(P<0.05)。多因素分析显示,PNI是影响患者预后的独立危险因素(P<0.05)。时间依赖的ROC曲线显示:PNI在预测患者术后的1年、3年及5年总体生存期的AUC分别为67.93%、70.44%及68.32%。对独立危险因素分层分析发现:CEA≤5.0 ng/mL、CA19-9≤39.0 U/mL、CA19-9>39.0 U/mL及N0患者中低PNI组和高PNI组总体生存时间具有统计学差异(P<0.05)。结论:术前PNI是肝内胆管癌根治性切除术后的独立危险因素,可用于患者预后预测。术前PNI对于CEA≤5.0 ng/mL、CA19-9≤39.0 U/mL、CA19-9>39.0 U/mL及N0者具有更好的预后预测价值。 相似文献
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Tumor DNA content has been advocated to be an important prognostic indicator in human malignancies. Paraffin-embedded specimens of 75 resected adenocarcinomas (AC) of the esophagogastric junction were studied by flow cytometric DNA analysis to determine whether tumor ploidy was a significant prognostic variable independent of stage and histologic grade of the tumor. Eighty-one percent of the tumors were aneuploid. More patients with aneuploid tumors had lymph node metastases than patients with diploid tumors (P = 0.007). Patients with aneuploid tumors had poorer 18-month disease-free and overall survival than patients with diploid tumors. Cox regression analysis demonstrated that the most important prognostic variables for predicting overall survival were lymph node status, depth of wall invasion, and tumor differentiation. Tumor ploidy was not an independent prognostic variable in predicting recurrent disease or death from AC of the esophagogastric junction. Tumor DNA content is valuable, however, as a marker for patients at increased risk of lymph node metastases, early recurrence, and poorer survival. 相似文献
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Expression of annexin A1 in esophageal and esophagogastric junction adenocarcinomas: association with poor outcome. 总被引:7,自引:0,他引:7
Kim L Wang Tsung-Teh Wu Erika Resetkova Huamin Wang Arlene M Correa Wayne L Hofstetter Stephen G Swisher Jaffer A Ajani Asif Rashid Stanley R Hamilton Constance T Albarracin 《Clinical cancer research》2006,12(15):4598-4604
PURPOSE: Annexin A1 (ANXA1) is a calcium-binding protein involved in arachidonic acid metabolism and epidermal growth factor receptor tyrosine kinase pathway. ANXA1 has been implicated in early squamous cell carcinogenesis of esophagus and correlates with degree of tumor differentiation. However, the role of ANXA1 in esophageal adenocarcinoma is unclear. Our goal was to evaluate ANXA1 expression and determine its prognostic significance in adenocarcinoma of the esophagus and esophagogastric junction. EXPERIMENTAL DESIGN: This study included 104 consecutive patients with primary resected esophageal and esophagogastric junction adenocarcinomas (11 stage I, 24 stage II, 53 stage III, and 16 stage IV). ANXA1 protein expression in each tumor was assessed by immunohistochemical staining of tissue microarrays. ANAX1 expression level was classified as high (>/=25% of tumor cells with cytoplasmic staining), low (<25% of tumor cells with cytoplasmic staining), or negative; and was correlated with clinicopathologic features and patients' outcomes. RESULTS: High ANXA1 expression was present in 39% (41 of 104) of tumors and was associated with higher pathologic T stage (P = 0.03) and distant metastasis (P = 0.04). High ANXA1 expression correlated with increased recurrence rate (P = 0.004) and decreased overall survival (P = 0.003) in univariate analysis. In multivariate analysis, ANXA1 expression and pN stage significantly correlated with recurrence rate (P = 0.008 and P < 0.001, respectively) and overall survival (P = 0.02 and P < 0.001, respectively) independent of T stage. CONCLUSION: Our results indicate that high ANXA1 expression is frequent in esophageal and esophagogastric junction adenocarcinomas, correlates with more advanced pathologic T stage and the presence of distant metastasis, and is an independent prognostic factor for patient survival. 相似文献
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目的:对比经上腹左胸手术和Ivor-lewis手术治疗Siewert Ⅱ型食管胃交界部腺癌(adenocarcinoma of the esophagogastric junction,AEG)在术中和术后各参数中的差别,以及患者预后的差异。方法:回顾性收集320例于河北医科大学第四医院胸外科行根治性手术的Siewert Ⅱ型 AEG患者的数据,其中行上腹左胸手术的患者175例,行Ivor-lewis手术的患者145例。比较两组患者的临床病理特征、术中和术后情况、总生存时间(overall survival,OS)和无病生存时间(disease-free survival,DFS),并对影响AEG患者预后的情况进行单因素和多因素分析。结果:两组患者在肿瘤最大直径、pTNM分期、pN分期和下残阳性方面比较有统计学差异(P<0.05);与Ivor-lewis手术相比,行上腹左胸手术患者的术中时间缩短了30 min(P=0.034),术后吻合口瘘发生率更低(1.71% vs 4.83%,P=0.041);相比Ivor-lewis患者,行上腹左胸手术的患者可以获得更好的OS和DFS(P<0.05);单因素和多因素分析显示术前新辅助治疗是Siewert Ⅱ型AEG患者预后的影响因素(P<0.05)。结论:经上腹左胸手术可以彻底切除肿瘤,保留膈肌的完整,缩短开胸时间,有利于术后快速康复。同时,术后吻合口瘘等并发症的发生率低,有利于及时进行术后辅助治疗,更利于改善AEG患者的预后。 相似文献
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目的:探讨老年直肠癌术后吻合口瘘的高危因素。方法:选择我院于2014年5月至2018年5月期间收治的老年直肠癌患者437例,均采用腹腔镜直肠癌根治法。分析影响老年直肠癌术后吻合口瘘的高危因素。影响因素包括性别、术前白蛋白、手术时间、合并高血压、合并糖尿病、吻合口距肛缘距离、肠梗阻、Dukes分期、BMI、出血量、血管侵犯和神经侵犯。结果:老年直肠癌患者行腹腔镜根治术后发生吻合口瘘29例,发生率为6.64%。经单因素分析表明,两组性别、合并高血压、合并糖尿病、Dukes分期、BMI、出血量和神经侵犯比较差异无统计学意义(P>0.05);吻合口瘘组术前白蛋白≤35 g/L、手术时间>3 h、吻合距肛缘距离≤7 cm、肠梗阻、血管侵犯人数明显增多,差异具有统计学意义(P<0.05)。将上述单因素分析差异具有统计学意义的纳入多因素分析显示,术前白蛋白≤35 g/L、手术时间>3 h、吻合距肛缘距离≤7 cm、肠梗阻和血管侵犯为影响术后吻合口瘘的高危因素。结论:老年直肠癌术后吻合口瘘受术前白蛋白、手术时间、吻合距肛缘距离、肠梗阻和血管侵犯影响,为降低术后吻合口瘘,需按照相关因素采取针对性预防措施。 相似文献
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目的:探讨术前预后营养指数(prognostic nutrition index,PNI)在脑胶质瘤患者术后临床预后中的应用。方法:收集2011年1月至2017年6月四川省大邑县人民医院神经外科手术治疗且经术后病理确诊的131例初发脑胶质瘤患者的临床资料及术后生存资料,采用ROC曲线分析获得PNI的最佳临界值,依据该最佳临界值将患者分为高PNI值组及低PNI值组,采用卡方检验比较两组临床病理学特征,采用Cox比例风险回归模型分析PNI与胶质瘤患者术后临床预后的关系。结果:131例脑胶质瘤患者术后中位总生存时间(overall survival,OS)为23个月,95%CI:9.736~36.264个月,术后1年、2年、3年、5年生存率分别为76.3%、52.0%、43.0%、33.5%。ROC曲线分析,PNI的最佳临界值为48.5。低PNI值组中年龄≥45岁、行非全切手术和较低级别肿瘤分级所占的比例较高PNI值组更高(P<0.05)。多因素Cox回归分析显示,肿瘤分级、PNI值是影响脑胶质瘤患者术后预后的独立影响因素。结论:PNI值为脑胶质瘤患者预后的独立危险因素,较低的PNI水平预示着较差的预后。PNI值可用于初步判断脑胶质瘤患者的预后。 相似文献
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目的 分析手术方式选择对左侧结肠癌并发急性肠梗阻根治的疗效.方法 回顾性分析31例实施左半结肠Ⅰ期根治性切除肠吻合术患者(根治组)和31例Ⅰ期切除吻合近端造瘘患者(吻合造瘘组)的临床资料,对比分析2组患者临床治疗效果及影响因素.结果 与吻合造瘘组患者比较,根治组患者手术时间短、术中出血量少,差异有统计学意义(P<0.05);与根治组患者比较,吻合造瘘组患者术后排气时间、进食时间以及胃管拔除时间均较短,差异有统计学意义(P<0.05);2组患者总住院时间差异不具统计学意义(P>0.05).吻合造瘘组患者术后吻合口瘘发生率显著低于根治组,差异有统计学意义(χ2=5.229,P=0.035);2组患者术后切口感染以及腹腔感染发生率差异不具统计学意义(P>0.05).左侧结肠癌并发急性肠梗阻预后与病理类型、临床分期、术后化疗以及手术方式有关,与患者性别和年龄无关.影响患者术后生存的独立危险因素为手术方式,根治性手术患者生存率更高.结论 左侧结肠癌并发急性肠梗阻行根治性手术患者术后生存率较高,手术方式是患者术后生存的独立危险因素. 相似文献
20.
Yumin Zhou Jiong Pan Yuwei Sheng Hao Liu Ziping Fan 《中德临床肿瘤学杂志》2007,6(3):P220-P221
Objective: To evaluate the treatment effects of total gastrectomy (TG) and proximal gastrectomy (PG) for cancer of the cardia and esophagogastric junction. Methods: forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results: The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant (X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05). The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion: Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction. 相似文献