腹腔镜低位直肠癌根治术中保肛因素的Logistic分析

目的探讨腹腔镜低位直肠癌根治术中影响保肛的相关因素。方法回顾性分析2013年6月至2016年6月在本院行腹腔镜下局部进展期低位直肠癌根治术的93例患者的临床资料，采用Logistic回归分析影响保肛的相关因素并比较39例患者行新辅助治疗前后临床指标的差异。结果单因素分析显示性别（χ2＝4．521，P＝0．033）、肿瘤距肛缘的距离（t＝36．131，P＜0．001）、肿瘤直径（t＝7．235，P＝0．007）、局部浸润深度（χ2＝17．531，P＜0．001）和是否行新辅助治疗（χ2＝4．366，P＝0．037）是影响保肛的因素。多因素分析显示性别（OR 47．59，95％CI 2．262～1001．326，P＝0．013）、肿瘤距肛缘的距离（OR 539．28，95％CI 15．165～19177．534，P＝0．001）、局部浸润深度（OR 0．005，95％CI 0．000～0．124，P＝0．001）和是否行新辅助治疗（OR 0．019，95％CI 0．001～0．601，P＝0．024）是影响保肛的关键因素。低位直肠癌行新辅助治疗后对比治疗前：肿瘤直径缩小（P＜0．001）、肿瘤距肛缘的距离增大（P＜0．001）、局部浸润深度降低（P＜0．001）、淋巴结阳性率下降（P＝0．020）。结论性别、肿瘤距肛缘的距离、肿瘤直径、浸润深度、是否行新辅助治疗是影响腹腔镜下局部进展期低位直肠癌保肛手术的因素。新辅助治疗能够使肿瘤降期，提高保肛率。

Factors for anal reservation in radical laparoscopic resection of low rectal cancer:a Logistic analysis

Objective To investigate the effects of anal retention factors in the laparoscopic low rectal cancer resection. Methods From June 2013 to June 2016,ninety-three patients with laparoscopic locally advanced low rectal cancer resection were reviewed at our institution. According to their clinical data , factors affecting the anal sphincter preservation were assessed by logistic regression. The clinical parameters of 39 patients before and after neoadjuvant therapy were compared. Results Univariate logistic regression analysis showed that gender (χ2=4.521,P=0.033),distance from the lower pole of tumor to the anal margin (t=36.131,P<0.001), tumor size (t=7.235,P=0.007), depth of invasion (χ2=17.531,P<0.001) and neoadjuvant therapy (χ2=4.366,P=0.037) were the factors for anus preservation. Multivariate logistic regression analysis showed that gender (OR 47.59, 95%CI 2.262~1001.326, P=0.013), distance from the lower pole of tumor to the anal margin (OR 539.28, 95%CI 15.165~19177.534, P=0.001), depth of invasion (OR 0.005, 95%CI 0.000~0.124, P=0.001), neoadjuvant therapy (OR 0.019, 95%CI 0.001~0.601, P=0.024) were the independent risk factors for anus preservation. Compared the clinical factors of low rectal cancer after neoadjuvant therapy with before, tumor diameter was reduced (P<0.001), distance of the tumor from the anal margin was increased (P<0.001), depth of invasion was decreased (P<0.001), positive rate of lymph node was reduced (P=0.020). Conclusions This article suggests that gender, tumor size, depth of invasion, distance from tumor to the anal margin and neoadjuvant therapy were risk factors which impact on anal reservation in radical laparoscopic resection of low rectal cancer. Besides , neoadjuvant treatment can reduce tumor stages, thereby increasing the rate of anal preservation.