CAJ | 학술논문

目的：比较低位直肠癌经腹会阴联合切除术（APR）和前切除术（AR）后的临床疗效。方法回顾性分析北京大学人民医院1998年1月至2010年12月间接受APR（151例，APR组）和AR（158例，AR组）术式的低位直肠癌患者的临床资料，比较两组短期结局指标、局部复发率、总生存率及无进展生存率。结果 APR组较AR组患者的手术时间长[（268．5±66．7） min比（247．4±64．2） min，P＝0．005]，术中出血量[（668．5±680．1） ml比（441．8±478．6） ml，P＝0．001]和术后引流量多[（66．9±54．7） ml比（49．0±45．9） ml，P＝0．002]。两组患者局部复发率的差异无统计学意义（ P＝0．188），但对于T3～T4期患者，APR组患者的5年局部复发率（24．9％）明显高于AR组（13．9％）（P＝0．038）。肿瘤下缘距肛门4～6 cm的T3～T4期APR组患者的5年局部复发率（27．5％）明显高于AR组（13．0％）（P＝0．038）。两组的总生存率和无进展生存率的差异均无统计学意义（均P＞0．05）；但当体质量指数大于或等于24 kg／m2时，APR组T3～T4期患者的5年总生存率（43．1％）和无进展生存率（42．8％）均明显低于AR组（87．9％和76．9％，P＝0．022和P＝0．041）。结论低位直肠癌APR和AR术后患者总体预后相当，但当患者肿瘤位于距肛缘4～6 cm、T3～T4分期和肥胖时，APR术后患者总体预后较差。
목적：비교저위직장암경복회음연합절제술（APR）화전절제술（AR）후적림상료효。방법회고성분석북경대학인민의원1998년1월지2010년12월간접수APR（151례，APR조）화AR（158례，AR조）술식적저위직장암환자적림상자료，비교량조단기결국지표、국부복발솔、총생존솔급무진전생존솔。결과 APR조교AR조환자적수술시간장[（268．5±66．7） min비（247．4±64．2） min，P＝0．005]，술중출혈량[（668．5±680．1） ml비（441．8±478．6） ml，P＝0．001]화술후인류량다[（66．9±54．7） ml비（49．0±45．9） ml，P＝0．002]。량조환자국부복발솔적차이무통계학의의（ P＝0．188），단대우T3～T4기환자，APR조환자적5년국부복발솔（24．9％）명현고우AR조（13．9％）（P＝0．038）。종류하연거항문4～6 cm적T3～T4기APR조환자적5년국부복발솔（27．5％）명현고우AR조（13．0％）（P＝0．038）。량조적총생존솔화무진전생존솔적차이균무통계학의의（균P＞0．05）；단당체질량지수대우혹등우24 kg／m2시，APR조T3～T4기환자적5년총생존솔（43．1％）화무진전생존솔（42．8％）균명현저우AR조（87．9％화76．9％，P＝0．022화P＝0．041）。결론저위직장암APR화AR술후환자총체예후상당，단당환자종류위우거항연4～6 cm、T3～T4분기화비반시，APR술후환자총체예후교차。
Objective To compare clinical efficacy between abdominoperineal resection (APR) procedure and anterior resection (AR) procedure in patients with rectal cancer. Methods Clinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People′s Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival (OS) and progression-free survival (PFS) were investigated between two groups. Results As compared to the AR group, the operative time was longer [(268.5± 66.7) min vs. (247.4±64.2) min, P=0.005], blood loss[(668.5±680.1) ml vs.(441.8±478.6) ml, P=0.001] and drainage volume were more [(66.9±54.7) ml vs. (49.0±45.9) ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3~T4 patients undergoing APR procedure (24.9%) was higher than that of AR group (13.9%)(P=0.038), especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS (P=0.273) and PFS (P=0.589) between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI≥24 undergoing APR procedure (43.1% and 42.8%) were significantly worse than those of patients undergoing AR procedure (87.9% and 76.9%, P=0.022 and P=0.041). Conclusions The overall prognosis of patients after APR and AR iscomparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.