穿孔性结直肠癌一期切除32例临床病理学特点及预后分析

Pathological character and prognosis of 32 patients with perforated colorectal cancer treated by single-stage surgery

目的:探讨一期切除的穿孔性结直肠癌临床病理学特点及预后。方法:回顾性分析2000年1月—2005年1月收治的32例行一期切除的穿孔性结直肠癌患者(穿孔组)的临床资料,其中TNM分期Ⅱ期21例,Ⅲ期11例。以同期择期手术切除结直肠癌患者556例(TNM分期Ⅱ期412例,Ⅲ期144例)作为对照组。结果:穿孔组17例行Hartmann手术,15例一期吻合;5年总存活率为21.9%,Ⅱ期患者5年存活率为28.6%,Ⅲ期患者5年存活率为9.1%;复发主要为腹膜种植(69%)。对照组5年总存活率为52.7%,Ⅱ期患者5年存活率为70.1%,Ⅲ期患者5年存活率为12.5%。对照组Ⅱ期患者5年存活率明显高于穿孔组(P<0.05),而Ⅲ期患者5年存活率2组差异无统计学意义(P>0.05)。结论:穿孔性结直肠癌复发形式主要为腹膜种植,且5年存活率低。术后辅助化疗很重要,尤其是腹腔内灌注化疗可能提高其存活率。

Objective：To study the pathological characters and prognosis of 32 patients with perforated colorectal cancer who were treated by single-stage surgical procedure. Methods： From January 2000 to January 2005,clinical data of 32 patients with perforated colorectal cancer treated by single-stage surgery were collected. Among them,21 patients were in（TNM） stage Ⅱ and 11 cases in stage Ⅲ. Five hundred fifty-six patients with no-perforated colorectal cance（r412 cases in stage Ⅱ,144 cases in stage Ⅲ） treated by surgical procedure were taken as control group. Results： Among 32cases,17 cases were treated by Hartmann procedure,the other 15 cases by single-stage anastomosis. The overall 5-year survival rate was 21.9% .The 5-year survival rate was 28.6% in stage Ⅱ and 9.1% in stage Ⅲ. Recurrence rate was 69% largely due to implantation metastasis in peritoneum. In control group,the overall 5-year survival rate was 52.7%. The 5-year survival rate was 70.1% in stage Ⅱ and 12.5% in stage Ⅲ. The 5-year survival rate in control group was more higher significantly than that of in perforated group in stage Ⅲ（P0.05） . However,there was no significant difference between these two groups（P0.05） . Conclusion： The recurrence mainly occurs in peritoneum in patients with perforated colorectal cancer,and the 5-year survival rate is lower,comparing with the no-perforated colorectal cancer patients. So the adjuvant chemotherapy likes very important for those patients. More importantly,the survival rate maybe improved by the peritoneal perfusion chemotherapy .