CAJ | 학술논문

目的：探讨直肠癌全直肠系膜切除术后局部复发的相关影响因素。方法选择接受全直肠系膜切除术的直肠癌患者278例，其中有14例发生术后局部复发。用单因素分析和Logistic回归分析患者术后局部复发的影响因素。结果278例直肠癌全直肠系膜切除术患者中有14例发生局部复发，占患者总人数的5．04％。直肠癌全直肠系膜切除术后患者的局部复发主要与分化程度、肿瘤穿孔、癌灶距肛缘距离、浸润深度、远切缘长度、淋巴结转移、病理类型、术后放化疗、术前肠梗阻、吻合口瘘等因素有关（P＜0．05），与性别、年龄、肿瘤直径、肿瘤分型、手术方式、肿瘤周径无关（P＞0．05）。将上述因素纳入Logistic多元回归分析，显示分化程度、肿瘤穿孔、癌灶距肛缘距离、浸润深度、远切缘长度、淋巴结转移、病理类型、术后放化疗、术前肠梗阻、吻合口瘘是引起直肠癌全直肠系膜切除术后局部复发的独立危险因素（P＜0．05）。结论直肠癌全直肠系膜切除术后的局部复发率较低，受多种因素的影响，其中吻合口瘘、肿瘤穿孔、分化程度、术前肠梗阻是最重要的影响因素。
목적：탐토직장암전직장계막절제술후국부복발적상관영향인소。방법선택접수전직장계막절제술적직장암환자278례，기중유14례발생술후국부복발。용단인소분석화Logistic회귀분석환자술후국부복발적영향인소。결과278례직장암전직장계막절제술환자중유14례발생국부복발，점환자총인수적5．04％。직장암전직장계막절제술후환자적국부복발주요여분화정도、종류천공、암조거항연거리、침윤심도、원절연장도、림파결전이、병리류형、술후방화료、술전장경조、문합구루등인소유관（P＜0．05），여성별、년령、종류직경、종류분형、수술방식、종류주경무관（P＞0．05）。장상술인소납입Logistic다원회귀분석，현시분화정도、종류천공、암조거항연거리、침윤심도、원절연장도、림파결전이、병리류형、술후방화료、술전장경조、문합구루시인기직장암전직장계막절제술후국부복발적독립위험인소（P＜0．05）。결론직장암전직장계막절제술후적국부복발솔교저，수다충인소적영향，기중문합구루、종류천공、분화정도、술전장경조시최중요적영향인소。
Objective To study the related factors of local recurrence of rectal cancer after total mesorectum excision. Methods 278 cases of rectal cancer underwent total mesorectum excision were selected.14 cases among them had postoperative local recurrence,single factor analysis and logistic regression was used to analyze the influence factors of patients with postopera-tive local recurrence.Results 14 cases of 278 cases of colorectal cancer underwent total mesorectum excision had local recur-rence,accounting for 5.04%.Postoperative local recurrence of rectal cancer was mainly related to degree of differentiation,tumor perforation,infiltration depth,anal edge distance between the cutting edge length,lymph node metastasis and pathological types, radiation and chemotherapy after operation,preoperative intestinal obstruction,anastomotic fistula and other factors(P<0.05), and it was not related to gender,age,tumor diameter,tumor classification,operation method,and tumor diameter (P>0.05).Tak-ing the above factors into the logistic multivariate regression analysis,it showed that the degree of differentiation,tumor perfora-tion,infiltration depth,anal edge distance between the cutting edge length,lymph node metastasis and pathological type,radiation and chemotherapy after operation,preoperative intestinal obstruction,anastomotic fistula were independent risk factors for local re-currence in colorectal cancer after total mesorectum excision (P<0.05).Conclusion Local recurrence rate of rectal cancer af-ter total mesorectum excision is low,is influenced by many factors,anastomotic fistula,tumor perforation,degree of differentiation, preoperative intestinal obstruction are the most important influencing factors.