627例大肠癌患者的综合分析

Comprehensive analysis of 627 cases with colorectal carcinoma.

目的了解近年来大肠癌的临床流行病学特点及变化趋势,从而提出相应的预防措施。方法回顾性调查苏州大学附属第一医院1999年1月~2003年12月间收治的原发性结直肠癌患者627例,分析结直肠癌的发病和预后的影响因素。结果①近年来大肠癌发病呈高龄化趋势,且右半结肠癌的比例有所上升;②男女患者在肿瘤的病理类型及部位构成上差异无统计学意义（P〉0.05）;③大肠癌中有胆囊结石合并胆囊切除史的患者明显多于对照人群（分别为16.1%和3.17%,P〈0.001）。而且,右半结肠癌的胆囊手术率显著高于左半结肠癌及直肠癌（P=0.001）;④大肠癌中有阑尾手术史的患者明显多于对照人群（分别为7.34%和1.74%,P〈0.001）;⑤大肠癌中有血吸虫病史的患者明显多于对照人群（分别为13.4%和2.22%,P〈0.001）;⑥结直肠癌患者的5年生存率为63.4%,中位生存时间为69.50个月;⑦应用Cox比例危险回归模型显示,贫血、肠壁的浸润程度、远处转移和肿瘤分化程度是影响结直肠癌患者术后生存的独立因素。结论根据苏州市大肠癌流行特征及预后因素分析,预防、早期诊断及综合治疗对控制大肠癌十分重要。

Objective To comprehand and grasp epidemical distribution characteristics of colorectal cancer cases.Methods Between 1999 and 2003,627 cases of colorectal carcinoma who had undergone a surgery in the First Affiliated Hospital of Suzhou University were retrospectively studied,and the clinical characteristics and the prognostic factors of these patients were analyzed.Results ①More elder cases were found in recent years,the incidence of right hemi-colon cancer was increased;②No significant differences were found in pathologic styles and tumor sites between male and female patients（P0.05）;③The rate of cholecystolithiasis and cholecystectomy was significantly higher in colorectal cancer patients than that in other cancer controls（16.1%vs.3.17%,respectively,P0.001）.Moreover,as compared with left-sied colon cancer and rectum cancer,the rate of cholecystectomy was higher also in righ-side colon cancer group（P=0.001）;④The rate of operation on appendix was significantly higher in colorectal cancer patients,than that in controls（7.34%vs.1.74%,respectively,P0.001）;⑤The rate of bilharziasis was significantly higher in colorectal cancer patients,than that in controls（13.4%vs.2.22%,respectively,P0.001）;⑥The 5-year survival rates of patients with colorectal cancer was 63.4% with a median survival of 69.50 moths;⑦Anaemia,intramural spread,distant metastasis and differentiation degree were available independent prognostic factors through multivariate analysis.Conclusion According to comprehensive analsis of the epidemical and prognostic features of colorectal cancer in Suzhou,strategy for prevention and early detection and combined treatment may have an important role in fighting against colorectal cancer.