结直肠癌患者术后预后营养指数在预后评估中的应用

目的 评估结直肠癌患者术后的预后营养指数(Postoperative prognostic nutritional index,p-PNI)在预后评估中的应用价值。方法 回顾性分析2009年8月-2012年8月间南京鼓楼医院集团宿迁市人民医院收治的经病理确诊为结直肠癌并行结直肠癌根治术的89例患者的临床资料。根据患者出院后第一次复诊的血常规及生化检查结果计算p-PNI。采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)计算Youden指数,以最佳敏感度和特异度组合的PNI值作为PNI分组的分界值。Kaplan-Meier法绘制生存曲线,Cox回归模型筛选研究p-PNI对结直肠癌患者术后预后的影响。结果 89例结直肠癌患者p-PNI为25.18~60.74(43.81±6.47)。患者中年龄小于70岁、淋巴结转移数目小于4个、术前CEA小于5ng/mL、术中出血量小于150mL的p-PNI显著增高(P＜0.05)。p-PNI值为43时,Youden指数最大。数据分析显示p-PNI与患者年龄、淋巴结转移数目、术中出血量及术前CEA值具有相关性(P＜0.05)。高p-PNI组患者生存率高于低p-PNI组(χ²=15.639,P＜0.001)。单因素及多因素分析证实,p-PNI是影响结直肠癌患者预后的独立因素(HR=2.179,95%CI:1.057~3.561,P＜0.001)。结论 p-PNI在结直肠癌患者中是一个独立的预后影响因素,与结直肠癌患者术后的长期预后相关。     

结直肠癌患者术前营养状况对术后生活质量影响

目的 探讨术前营养风险对胃肠肿瘤患者术后生存质量的影响,并对临床营养治疗提出合理建议。方法 通过一 项回顾性研究,选取2014 年 6 月至2016 年 6 月上海交通大学附属第六人民医院普外科新入院结直肠癌患者150 例,入院 后 24 小时内,应用NRS 2002 评估其营养状况,根据评分将患者分为两组,即研究组（存在营养风险）和对照组（无营养 风险）,比较两组患者术后并发症之间的差异,运用欧洲癌症研究与治疗组织的生命质量核心量表比较两组间生存质量差 异。结果 NRS 2002结果显示对照组86例（57%）,研究组 64例（43%）。不同营养状况患者比较,研究组患者术后感染, 吻合口瘘的发生率显著高于对照组患者。两者整体生存质量,躯体功能、认知功能、疲乏、失眠差异有统计学意义（P＜0.05）; 而角色功能、情绪功能、社会功能、恶心呕吐、疼痛、气促、食欲丧失、便秘、腹泻、经济困难差异无统计学意义（P＞0.05）。 通过多元逐步线性回归分析得出术前营养状态可以作为患者术后生活质量的独立影响因素。结论 术前存在营养风险的结直 肠癌患者,术后并发症显著增加,术后生活质量下降,应加强对术前存在营养风险患者的营养治疗。     

结直肠癌术后腹腔免疫化疗的疗效观察

目的：观察腹腔免疫化疗在结直肠癌术后应用的疗效。方法：对46例结直肠癌术后患（DukesC期、D期）行腹腔免疫化疗，评价患生活质量、免疫指标改善，近期复发转移情况。结果：结直肠癌术后应用腹腔免疫化疗，患免疫指标改善，副反应轻，术后肿瘤复发，转移率下降。结论：腹腔免疫化疗对防治结直肠癌术后复发，转移是一种安全、方便有价值的方法。     

精氨酸增强结直肠癌患者术后免疫功能

对术后分别接受常规肠外营养支持或精氨酸增强的肠外营养支持(20g/d)的结直肠癌患者进行术前、术后的免疫功能检测 ,结果表明 ,两组患者入院均有明显的免疫抑制 ,精氨酸增强的肠外营养支持组患者的免疫功能 (CD4+、CD4+/CD8+、NK、IL_2R)在术后第4天 ,第7天与对照组相比有明显改善 (P<0.05)。     

不同中转开腹时机对腹腔镜结直肠癌患者术后恢复及生存情况的影响

目的 探讨不同中转开腹手术时机对腹腔镜结直肠癌患者术后恢复及生存情况的影响.方法 选取86例行腹腔镜结直肠癌根治术的结直肠癌患者,依据中转开腹的时机分为早期组(n=45)和延迟组(n=41),早期组患者于腹腔镜手术切皮后1h内中转开腹手术,延迟组患者于切皮后1h后中转开腹手术.比较两组患者围手术期相关指标、术后并发症发...     

高龄结直肠癌患者术后化疗依从性的影响因素分析

目的探讨高龄结直肠癌患者术后化疗的依从性及其影响因素。方法回顾性分析115例高龄结直肠癌患者的临床病例资料,其中65例接受术后辅助化疗,50例拒绝了术后化疗。对影响高龄结直肠癌患者术后化疗依从性的客观因素进行Logistic回归分析,并电话随访拒绝化疗患者的主观因素。结果多因素分析显示,性别、BMI、BSA、年龄及并发症是影响患者化疗依从性的独立因素（均P〈0．05）。主观因素方面,有12例（60．0％）Ⅱ期结直肠癌患者拒绝化疗是因为医生的建议程度不够。患者的恐惧心理（20．0％,3／15）、经济条件（20．0％,3／15）及对预后的绝望情绪（27．3％,3／11）是影响Ⅲ、Ⅳ期患者接受化疗的主要原因。结论患者的性别、BMI、BSA、年龄、并发症是影响高龄结直肠癌术后化疗依从性的客观指标。对于Ⅱ期患者,医生对化疗的建议程度应该加强;对于Ⅲ期患者,应调节患者负性情绪。     

环周切缘对中低位直肠癌患者预后的影响

目的探讨环周切缘(CRM)对中低位直肠癌患者预后的影响。方法回顾性分析180例行全直肠系膜切除术的中低位直肠癌患者的临床病理资料,并采用Kaplan-Meier法分析术后5年生存率、远处转移率和局部复发率跟CRM的关系。结果 CRM(<1 mm)阳性患者5年生存率明显较低,其远处转移率与局部复发率均明显较高(P<0.05)。结论 CRM阳性是仅次于TNM分期的一个对中低位直肠癌患者预后有重要影响的因素。     

直肠癌术后复发的治疗

几组回顾性调查结果表明 ,直肠癌手术后整体复发率超过 40 % ,即使最好的治疗中心其复发率也达 2 5 % ;其中Ｔ3～4Ｎ1～ 2Ｍ0的患者 ,疗后复发率可达 45 %～ 65 % [1 ] 。局部复发致死约占 5年死亡率的一半 ,另一半死于远地转移。即使使用有效的联合治疗 ,如术前、术后化疗加放射治疗 ,局部复发率仍有 1 0 %～ 1 5 %。直肠癌复发治疗困难 ,预后差 ,是广大临床工作者面临的棘手问题。现将直肠癌术后复发的治疗方法综述如下。一、手术治疗直肠癌术后复发如发生在吻合口 ,再次手术效果好。但这种预后好的患者仅占复发病例的 30 %以下 ,而 70 %…     

结直肠癌术后腹腔免疫化疗的疗效观察

目的　观察腹腔免疫化疗在结直肠癌术后应用的疗效。方法　对 4 6例结直肠癌术后患者(DukesC期、D期 )行腹腔免疫化疗 ,评价患者生活质量、免疫指标改善 ,近期复发转移情况。结果　结直肠癌术后应用腹腔免疫化疗 ,患者免疫指标改善 ,副反应轻 ,术后肿瘤复发 ,转移率下降。结论　腹腔免疫化疗对防治结直肠癌术后复发 ,转移是一种安全、方便有价值的方法     

椎旁阻滞联合全麻对结直肠癌切除术患者术后应激反应的影响

目的:探讨椎旁阻滞联合全麻对结直肠癌切除术患者术后应激反应的影响。方法:回顾性分析我院自2015年1月至2017年1月收治的结直肠癌患者104例,根据患者术中采用的麻醉方法,将患者分为观察组(n=58)和对照组(n=46),观察组术中给予椎旁阻滞联合全麻,对照组仅给予全麻。观察两组患者术后应激反应和术后康复情况。结果:两组患者术前应激激素血管紧张素II(AngII)、C反应蛋白(CRP)、皮质醇、焦虑自我评分(SAS)等比较差异均无统计学意义(P>0.05);术后24 h时观察组AngII显著低于对照组(P=0.001),CRP显著低于对照组(P=0.000),皮质醇显著低于对照组(P=0.009);与对照组比较,观察组患者术后24 h时SAS评分显著降低(P=0.000),视觉模拟评分显著降低(P=0.001);肛门排气时间显著减短(P=0.002);住院时间显著缩短(P=0.003),术后引流时间、引流量比较两组间无差异性（P>0.05）。结论:椎旁阻滞联合全麻有助于降低结直肠癌患者术后应激反应,加速患者术后康复。     

Short time to recurrence after hepatic resection correlates with poor prognosis in colorectal hepatic metastasis

BACKGROUND: Early recurrence is a major problem after hepatic resection of colorectal hepatic metastasis (CHM). Our aim was to investigate the relationship between time to recurrence after CHM resection and overall survival. METHODS: A retrospective analysis was performed for 101 consecutive patients who underwent hepatic resection for CHM and have been followed more than 5 years. RESULTS: Among 101 patients, 82 (81%) had a recurrence. Overall survival of patients with recurrence within 6 months after CHM resection was significantly worse than that of patients with recurrence after more than 6 months (P < 0.01). Overall survival was poorer when time to recurrence was shorter. One of the reasons for poor prognosis of patients with recurrence within 6 months was that only a few patients could undergo a second resection for recurrence after CHM resection. Histological type, including poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor, bilobar metastases, microscopic positive surgical margin and carcinoembryonic antigen (CEA) above 15 ng/ml had predictive value for decreased recurrence-free survival after CHM resection. CONCLUSION: Short time to recurrence after CHM resection correlates with a poor prognosis. Histological type of poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor might be a predictor for early recurrence after CHM resection.     

直肠癌脑转移患者预后的影响因素分析

目的：分析影响直肠癌脑转移患者预后的相关因素。方法：搜集2008年6月－2010年6月期间来我院治疗的100例直肠癌脑转移患者的临床资料,根据治疗方法分为实验组和对照组,实验组为行手术治疗的46例患者,对照组为行放化疗的54例患者。采用Logistic逐步回归分析,分析影响脑卒中瘫痪经手术治疗患者预后的因素。结果：实验组患者的平均生存时间、1年生存率、3年生存率以及5年生存率均优于对照组患者,具有明显差异（P＜0．05）。Logistic回归分析示,性别、原发肿瘤组织学分级等因素不是影响直肠癌脑转移患者预后的因素;影响直肠癌脑转移患者预后的相关因素是原发肿瘤直径、脑转移灶数目、血清CEA水平、治疗方法、脑转移灶治疗与否以及年龄。经Logistic回归逐步分析可知,血清CEA水平对患者预后的影响最大（OR＝3．743）,其次是脑转移灶数目（OR＝3．153）、治疗方法（OR＝2．946）,年龄（＞60岁）影响最小（OR＝1．900）。结论：影响直肠癌脑转移患者预后的相关因素是原发肿瘤直径、脑转移灶数目、血清CEA水平、治疗方法、脑转移灶治疗与否以及年龄等。及时掌握这些预后影响因素能够显著提高直肠癌脑转移患者生存状况,在临床上具有重要的临床意义。     

结直肠癌术后脂肪液化感染的脓液培养及感染源分析

目的:探讨结直肠癌术后脂肪液化感染的脓液的致病细菌及感染源,为防治术后感染提供参考,以降低结直肠癌患者术后感染率。方法:回顾分析2013年1月至2014年1月274例结直肠癌患者的临床资料,对术后脂肪液化感染的脓液做细菌培养,鉴定病原菌并就手术患者的年龄、性别、体质量指数、手术方式、手术时间、Dukes分期及是否使用抗菌药物等与术后脂肪液化感染的关系进行分析研究。结果:77例患者发生术后脂肪液化感染,感染率为28.1%。77例感染患者共分离出84株病原菌,以大肠埃希菌（33.33%）、金葡菌（16.67%）、铜绿假单胞菌（17.86%）为主。感染患者的BMI指数、手术时间、是否应用抗菌药物、Dukes分期存在统计学差异(P<0.05)。结论:结直肠癌患者发生术后感染与体质量指数、手术时间、是否使用抗菌药物、Dukes分期有较为密切的关系。     

Prognostic impact of genomic instability in colorectal cancer

Background:

The prognostic impact of an indication of chromosomal instability (CIN) is evaluated in a consecutive series of 952 colorectal cancer patients treated at Aker University Hospital, Norway, during 1993–2003. Microsatellite instability (MSI) in this case series has recently been reported and made it possible to find the co-occurrence and compare the prognostic significance of CIN and MSI.

Methods:

Data sets for overall survival (OS; n=855) and time to recurrence (TTR; n=579) were studied. To reveal CIN we used automated image cytometry (ICM). Non-diploid histograms were taken as indicative of the presence of CIN. PCR-based measures of MSI in this material have already been described.

Results:

As with MSI, CIN was found to be an independent predictor of early relapse and death among stage II patients (TTR: n=278: HR 2.19 (95% CI: 1.35–3.55), P=0.002). Of the MSI tumours (16%), 71% were found to be DNA diploid, 21% were DNA tetraploid and 8% were DNA aneuploid. Among microsatellite stable tumours, 24% were DNA diploid, 15% were DNA tetraploid and 61% were DNA aneuploid.

Conclusion:

For patients presenting with stage II disease, genomic instability as detected by DNA image cytometry has the potential to provide a useful biomarker for relapse and cancer-related death following surgery with curative intent.     

Isolated paraaortic lymph-node recurrence after the curative resection of colorectal carcinoma

BACKGROUND AND OBJECTIVES: Isolated paraaortic lymph-node recurrence (IPLR) after curative surgery for colorectal carcinoma is rare and no previous report has specifically addressed this type of recurrence. We investigated the clinical features of IPLR and analyzed prognostic factors. METHODS: Of 2,916 patients who underwent curative surgery for colorectal carcinoma, IPLR was identified in 38 patients (1.3%). The clinical features and prognostic factors of these patients were analyzed. RESULTS: IPLR was first detected by increased serum carcinoembryonic antigen (CEA) levels (63.2%) or by routine follow-up computed tomography (CT) (36.8%). Curative resection of IPLR was performed in six patients (15.8%). A total of 19 patients (50.0%) received chemoradiation therapy and 13 patients (34.2%) received chemotherapy only. The median survival from IPLR was 13 months (range: 5-60 months). The median survival time from IPLR for the resected patients was 34 months, whereas it was 12 months for those who did not undergo resection (P = 0.034). The factors associated with the prognosis were histological grade (P = 0.003), location (P = 0.032), and resection of IPLR (P = 0.034). CONCLUSIONS: IPLR after curative surgery for colorectal carcinoma is rare. Although it is generally associated with poor prognosis, better survival might be achieved through curative resection in selected cases.