中青年与老年直肠癌的临床及病理特征对比研究

目的分析中青年与老年直肠癌患者的临床及病理特征差异。方法回顾性分析经手术病理或肠镜活检确诊并行手术治疗的42例中青年直肠癌患者（中青年组，年龄〈60岁）和65例老年直肠癌患者（老年组，年龄≥60岁）的临床、病理及随访资料，分析两组患者的生存情况。结果中青年组直肠癌家族史发生率较老年组高（P〈0．05），首发症状中黏液脓血便、排便习惯改变发生率较老年组高（P〈0．05），便秘发生率较老年组低（P〈0．05）．发病至确诊时间较老年组长（P〈0．05）。两组在腹痛、腹部肿块为首发症状方面比较差异有统计学意义（P〈0．05）。与老年组比较，中青年组肿瘤多位于腹膜返折下（P〈0．05），腺癌发生率显著降低（P〈0．05），黏液和印戒细胞癌发生率显著升高（P〈0．05）；高分化肿瘤发生率显著降低，低分化发生率显著升高（P〈0．05）；两组患者肿瘤Dukes分期、平均生存时间、3年生存率比较差异无统计学意义（P〉0．05）。结论中青年直肠癌患者较老年患者发现晚．恶性程度高，受遗传因素影响大，首发症状较老年患者有明显差异，如能及早诊断和手术治疗，两者预后差异无统计学意义。

Clinical and pathological features of rectal cancer compared between young and elderly patients

Objective To analyze the differences of clinical and pathological features of rectal cancer between young and elderly patients. Methods The clinical, pathological and follow-up datas of 42 young patients with rectal cancer （young group,age〈60 years） and 65 elderly patients（elderly group,age ≥ 60 years） confirmed by pathology or enteroscope biopsy were retrospectively analyzed,and the survival situation of patients in the two groups was also investigated. Re- sults Compared with elderly group,the incidence of family medical history for rectal cancer in young group was statisti- cally higher （P〈0.05）,the incidence of bloody mucopurulent stool and altered bowel habit which were mainly as the ini- tial syndromes in young group were statistically higher（P〈0.05）,but the incidence of constipation was significantly lower （P〈0.05）,the time between onset and final diagnosis was obviously longer （P〈0.05）.There was statistical difference in stomachache or abdominal mass as the initial syndrome was observed between young group and elderly group （P〈0.05）. Compared with elderly group,most tumors in young group occurred below the peritoneum （P〈0.05）;the incidence of ade- nocarcinoma in young group was less（P〈0.05） and mucinous carcinoma as well as signet-ring cell carcinoma were more （P〈0.05）;well-differentiated tumor in young group was statistically lower and poor-differentiated tumor was statistically higher （P〈0.05）.The differences of Dukes stage,mean survival,3-year survival rate between the two groups were all not statistically significant（P〉0.i）5）. Conclusion Young patients with rectal cancer is characterized by late found,high grade malignancy and largely influenced by genetic factor,their initial symptoms are obviously different with elderly patients,if diagnosed and receiving operation early,young patients will obtain similar prognosis with elderly patients.