40岁以下青年人直肠癌的外科治疗及预后分析

Treatment and prognosis of patients under 40 years of age with rectal cancer

目的探讨青年直肠癌的外科治疗效果及影响其预后的因素。方法回顾性分析中国医学科学院肿瘤医院1990年1月至2000年1月收治的40岁以下青年直肠癌患者138例的临床资料。结果全组患者均经根治性手术治疗,其中腹会阴联合根治术81例,直肠前切除术54例,经肛直肠癌局部切除术3例。全组总的3年及5年生存率分别为67.7%及50.4%。单因素分析显示Dukes分期、淋巴结转移状况、性别、围手术期输血、肿瘤T分期、组织学类型及脉管瘤栓为影响预后的主要因素,而多因素分析显示肿瘤T分期、淋巴结转移是影响预后最重要的独立因素。结论对于青年直肠癌患者,根治性手术治疗是获得长期生存的惟一方法,肿瘤T分期和淋巴结转移情况是影响预后的最重要因素。

Objective To assess the treatment and prognosis of patients under 40 years of age with rectal carcinoma. Methods The data of 138 patients treated from January 1990 to January 2000 in Cancer Hospital of Chinese Academy of Medical Sciences were analyzed retrospectively. Curative resection was performed on all patients,including abdominoperineal resection(81),anterior resection(54),and transanal local excision(3). Postoperative complications developed in 4 patients(2.3%). No death occurred within 30 days after operation. Survival analysis was estimated using the Kaplan Meier method and compared using the Log rank test. Cox regression was used in multivariate analysis. Results The overall 3 and 5 year survival rates were 67.7%and 50.4%for the whole group. Dukes stage,lymph node metastasis,gender,blood transfusion,T stage,histological type and invading blood vessels were significantly associated with prognosis (P< 0.05). Cox regression showed that lymph node metastasis and T stage were the independent prognostic factors. Conclusions For young patients with rectal carcinoma,radical resection is the only approach to obtain long term survival. Lymph node metastasis and T stage were the independent prognostic factors. Early detection and treatment are crucial to improve the survival rate.