CAJ | 학술논문

目的：探讨直肠癌术后吻合口瘘对长期预后的影响。方法回顾性分析2007年1月至2011年12月间于福建医科大学附属协和医院结直肠外科获得R0切除并经病理确诊的653例直肠癌患者的临床病理资料，其中40例患者出现了吻合口瘘（吻合口瘘组），其余613例未发生吻合口瘘（非吻合口瘘组）。中位随访47（1～91）月，比较两组的5年无病生存率、远处转移率和局部复发率，并分析影响长期预后的危险因素。结果非吻合口瘘组5年无病生存率、远处转移率和局部复发率分别为78．1％、14．2％和4．2％，吻合口瘘组分别为74．5％、20．1％和8．4％，两组间的比较差异均无统计学意义（均P＞0．05）。多因素分析结果显示，术前行新辅助放化疗、TNM分期、糖链抗原（CA199）异常、术前白蛋白水平降低是R0切除直肠癌术后无病生存的独立预后因素（均P＜0．05），而吻合口瘘不是术后无病生存的独立预后因素（P＝0．910）。进一步对术后接受辅助化疗的507例患者进行多因素分析，结果亦显示，吻合口瘘并非术后无病生存的独立预后因素（P＞0．05）。结论吻合口瘘并不影响直肠癌患者的长期预后。
목적：탐토직장암술후문합구루대장기예후적영향。방법회고성분석2007년1월지2011년12월간우복건의과대학부속협화의원결직장외과획득R0절제병경병리학진적653례직장암환자적림상병리자료，기중40례환자출현료문합구루（문합구루조），기여613례미발생문합구루（비문합구루조）。중위수방47（1～91）월，비교량조적5년무병생존솔、원처전이솔화국부복발솔，병분석영향장기예후적위험인소。결과비문합구루조5년무병생존솔、원처전이솔화국부복발솔분별위78．1％、14．2％화4．2％，문합구루조분별위74．5％、20．1％화8．4％，량조간적비교차이균무통계학의의（균P＞0．05）。다인소분석결과현시，술전행신보조방화료、TNM분기、당련항원（CA199）이상、술전백단백수평강저시R0절제직장암술후무병생존적독립예후인소（균P＜0．05），이문합구루불시술후무병생존적독립예후인소（P＝0．910）。진일보대술후접수보조화료적507례환자진행다인소분석，결과역현시，문합구루병비술후무병생존적독립예후인소（P＞0．05）。결론문합구루병불영향직장암환자적장기예후。
Objective To investigate the influence of anastomotic leakage (AL) on long-term survival after resection for rectal cancer. Methods Clinicopathological data of 653 rectal cancer cases confirmed by pathology and undergoing R0 resection for rectal cancer in our department from January 2007 to December 2011 were retrospectively analyzed. Anastomotic leakage was found in 40 cases (AL group) and not in the other 613 cases (non-AL group). After median 47(1-91) months of follow-up, 5-year disease-free survival rate, distant metastasis rate and local recurrence rate were compared between the two groups. Risk factors affecting long-term prognosis were also analyzed. Results The 5-year disease-free survival rate, 5-year distant metastasis rate, and 5-year local recurrence rate were 78.1%, 14.2% and 4.2% in the non-AL group, and 74.5%, 20.1% and 8.4% in the AL group respectively, and the differences were not statistically significant(P=0.808, P=0.965, P=0.309). Multivariate analysis showed that preoperative neoadjuvant radiochemotherapy, TNM staging, abnormal CA199, preoperative low level of albumin were independent prognostic factors of rectal cancer patients after R0 resection , while AL was not an independent factor of 5-year disease-free survival (P=0.910). Further multivariate analysis on 507 cases receiving postoperative adjuvant chemotherapy also revealed that AL was not an independent factor of 5-year disease-free survival (P>0.05). Percentage difference of patients finishing postoperative chemotherapy between the two groups was not statistically significant (79.4% vs. 76.3%, P=0.681). Conclusion AL is not an independent predictor of long-term survival for rectal cancer.