中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
12期
1282-1286
,共5页
占小平%邵静涛%李定%潘德光
佔小平%邵靜濤%李定%潘德光
점소평%소정도%리정%반덕광
结直肠肿瘤,Ⅳ期%姑息性手术%术后并发症%围手术期死亡%远期生存
結直腸腫瘤,Ⅳ期%姑息性手術%術後併髮癥%圍手術期死亡%遠期生存
결직장종류,Ⅳ기%고식성수술%술후병발증%위수술기사망%원기생존
Colorectal neoplasms,stage Ⅳ%Palliative resection%Morbidity%Mortality%Long-term survival
目的 探讨影响Ⅳ期结直肠癌患者姑息性原发肿瘤切除术后并发症发生、围手术期死亡和长期生存的危险因素.方法 回顾性收集1996-2010年间在浙江省淳安第一人民医院接受原发肿瘤切除术但远处转移灶无法切除的189例Ⅳ期结直肠癌患者的临床资料.结果 86例(45.5％)患者围手术期出现并发症,其中内科并发症44例(24.0％),外科并发症63例(33.3％).高龄(65岁以上)(P=0.039)和急诊手术(P=0.001)是Ⅳ期结直肠癌患者原发肿瘤切除术后内科并发症的独立危险因素;肿瘤局部进展(T4) (P＝0.022)和广泛淋巴结转移(N2)(P＝0.009)是外科并发症的独立危险因素.17例(9.0％)患者围手术期死亡,高龄(P=0.013)、腹膜播散(P=0.010)、急诊手术(P＝0.001)和术后出现内科并发症(P=0.008)是围手术期死亡的独立危险因素.172例进入生存分析的患者,术后1、2、3年累计生存率分别为41.2％、22.7％和7.7％,淋巴结转移(P=0.015)和肿瘤分化程度(P=0.038)是Ⅳ期结直肠癌患者的独立预后因素.结论 Ⅳ期结直肠癌患者行原发肿瘤切除时,应尽量避免行急诊手术,尤其对于高龄和腹膜播散患者.低分化或广泛淋巴结转移的Ⅳ期结直肠癌患者,行原发肿瘤姑息性切除意义有限.
目的 探討影響Ⅳ期結直腸癌患者姑息性原髮腫瘤切除術後併髮癥髮生、圍手術期死亡和長期生存的危險因素.方法 迴顧性收集1996-2010年間在浙江省淳安第一人民醫院接受原髮腫瘤切除術但遠處轉移竈無法切除的189例Ⅳ期結直腸癌患者的臨床資料.結果 86例(45.5％)患者圍手術期齣現併髮癥,其中內科併髮癥44例(24.0％),外科併髮癥63例(33.3％).高齡(65歲以上)(P=0.039)和急診手術(P=0.001)是Ⅳ期結直腸癌患者原髮腫瘤切除術後內科併髮癥的獨立危險因素;腫瘤跼部進展(T4) (P＝0.022)和廣汎淋巴結轉移(N2)(P＝0.009)是外科併髮癥的獨立危險因素.17例(9.0％)患者圍手術期死亡,高齡(P=0.013)、腹膜播散(P=0.010)、急診手術(P＝0.001)和術後齣現內科併髮癥(P=0.008)是圍手術期死亡的獨立危險因素.172例進入生存分析的患者,術後1、2、3年纍計生存率分彆為41.2％、22.7％和7.7％,淋巴結轉移(P=0.015)和腫瘤分化程度(P=0.038)是Ⅳ期結直腸癌患者的獨立預後因素.結論 Ⅳ期結直腸癌患者行原髮腫瘤切除時,應儘量避免行急診手術,尤其對于高齡和腹膜播散患者.低分化或廣汎淋巴結轉移的Ⅳ期結直腸癌患者,行原髮腫瘤姑息性切除意義有限.
목적 탐토영향Ⅳ기결직장암환자고식성원발종류절제술후병발증발생、위수술기사망화장기생존적위험인소.방법 회고성수집1996-2010년간재절강성순안제일인민의원접수원발종류절제술단원처전이조무법절제적189례Ⅳ기결직장암환자적림상자료.결과 86례(45.5％)환자위수술기출현병발증,기중내과병발증44례(24.0％),외과병발증63례(33.3％).고령(65세이상)(P=0.039)화급진수술(P=0.001)시Ⅳ기결직장암환자원발종류절제술후내과병발증적독립위험인소;종류국부진전(T4) (P＝0.022)화엄범림파결전이(N2)(P＝0.009)시외과병발증적독립위험인소.17례(9.0％)환자위수술기사망,고령(P=0.013)、복막파산(P=0.010)、급진수술(P＝0.001)화술후출현내과병발증(P=0.008)시위수술기사망적독립위험인소.172례진입생존분석적환자,술후1、2、3년루계생존솔분별위41.2％、22.7％화7.7％,림파결전이(P=0.015)화종류분화정도(P=0.038)시Ⅳ기결직장암환자적독립예후인소.결론 Ⅳ기결직장암환자행원발종류절제시,응진량피면행급진수술,우기대우고령화복막파산환자.저분화혹엄범림파결전이적Ⅳ기결직장암환자,행원발종류고식성절제의의유한.
Objective To investigate the independent predictors of postoperative mortality,morbidity,and long-term survival in patients with stage 1Ⅳ colorectal cancer.Methods Clinical data of 189 patients with stage Ⅳ colorectal cancer undergoing palliative resection of primary tumor in the presence of unresectable synchronous metastases were analyzed retrospectively.Results Eighty-six (45.5％)patients developed postoperative complications.Preoperative predictors of medical complications included age(≥65,P=0.039) and emergency operations (P=0.001).Preoperative predictors of surgical complications included advanced local disease (T4,P=0.022) and lymph node spread (N2,P=0.009).Seventeen (9.0％) patients died in the postoperative period.Mortality was independently associated with age (P=0.013),peritoneal dissemination (P=0.010),emergency operations (P=0.001) and medical complications (P=0.008).The survival rates at 1-,2-,and 3-year of 172 patients admitted in survival analysis were 41.2％,22.7％ and 7.7％ respectively.Independent factors associated with poor overall survival included lymph node spread (N2,P=0.015) and poor tumor differentiation (P=0.038).Conclusions Emergency operations should be avoid when palliative resection of primary tumor is considered for stage Ⅳ colorectal cancer patients,especially for elderly patients and those with peritoneal dissemination.The significance of palliative resection is limited for stage Ⅳ colorectal cancer patients with lymph node spread and poor tumor differentiation.
