直肠癌根治术的远期疗效分析

Long-term results after radical resection in patients with rectal cancer

目的探讨直肠癌根治术后远期效果和影响手术疗效的相关因素。方法收集和分析1990年1月至1999年12月689例根治性切除直肠癌患者的资料。结果全组手术死亡率0.7%,随访率96.7%,术后1、3、5、10年生存率分别为89.9%、77.3%、69.6%和63.3%,中位生存期为67.4个月。单因素分析显示,直肠癌术后生存率与首发症状、肿瘤位置、肿瘤侵犯肠管周径比例、大体类型、组织类型、侵犯肠壁深度(T分期)、淋巴结转移的范围、Dukes分期和术式等因素相关。采用Cox多因素回归分析,结果显示仅肿瘤位置、组织类型、侵犯肠壁深度及Dukes分期是直肠癌根治术后长期生存的独立影响因子。结论直肠癌根治术后远期疗效与肿瘤位置、组织类型、侵犯肠壁深度及Dukes分期相关。

Objective To analyze the long- term results of radical resection for rectal cancer and the factors influencing the operative results. Methods From January 1990 to December 1999,clinical data of 689 patients who underwent radical resection for rectal cancer were analyzed retrospectively. Results The overall operative mortality was 0.7% ,the follow- up rate was 96.7% ,the median survival rate was 67.4 months. The 1- , 3- , 5- and 10- year survival rate after operation was 89.9% , 77.3% , 69.6% and 63.3% respectively. Univariate analysis showed that the survival rate was related with the first onset symptom,tumor location,infiltrated circumference of intestine,T staging, Dukes staging, histological type,extent of lymph node metastasis and operative approaches. Multivariate analysis showed that tumor location,histological type,invasive depth and Dukes staging were independent prognostic factors. Conclusion The long- term efficacy after radical resection for rectal cancer is correlated with tumor location,histological type,invasive depth and Dukes staging.