青年人结直肠癌的外科治疗

Surgical treatment for young patients with colorectal cancer:an analysis of 216 cases

目的探讨青年结直肠癌病人的临床病理特点及外科治疗方法。方法对哈尔滨医科大学附属第三临床医学院1976-2007年收治的216例30岁以下结直肠癌病人的发生率、部位、临床症状、术前合并症、术式、病理、术后并发症等因素进行回顾分析。结果男性137例,女性79例,占同期手术病人的5.2%。病变部位以直肠(136例)和乙状结肠(41例)多见,占总数81.9%(177/216)。直肠癌距肛缘平均距离4.5cm。右半结肠13例,占总数6.0%。以大便习惯改变和间歇性黏液血便为主要症状。术前合并肠梗阻、肠穿孔、严重贫血等33例(15.3%)。159例(73.6%)行根治术,57例(26.4%)行姑息术。根治术、姑息术5年存活率分别为46.4%和0。急诊手术13例(6.0%)。术后15例(6.9%)出现肠梗阻、出血、感染等并发症。结论青年结直肠癌病人,发病部位以直肠多见。病理以低分化腺癌、印戒细胞癌较多,易发生转移与种植,预后差。加强直肠肛诊检查,以期早期诊断和早期治疗。术式以保留神经的扩大根治术为首选,可达到较高的根治率和生活质量。

Objective To investigate the clinicopathological features and surgical treatment of young patients with colorectal cancer. Methods Between 1976 and 2007, 216 cases of histologically proven colorectal cancer who were no more than thirty years old admitted at the Third Affiliated Hospital of Harbin Medical University were included in the study. The clinicopathological factors based on patient, operation, and tumor findings were analyzed retrospectively. Results There were 137 male patients and 79 female patients. The rectum and sigmohl colon were the most popular sites in young patients with colorectal cancer. There were 136 patients with rectum cancer and 41 patients with sigmoid colon cancer. The average distance from rectal cancer to anal verge was 4.5cm. There were only 13 patients with right hemicolon cancer. Thirty three patients had complicated diseases before operation, such as intestinal obstruction, intestinal perforation and serious hemophthisis. One hundred and fifty nine patients performed radical excision while 57 patients were performed palliative resection. The 5-year surviral rate of radical excision and palliative resection was 46.4% arid respectively. Thirteen patiants wrer performed emergency surgery Fifteen patients had complicated diseases after operation, such as intestinal obstruction, hemori＇hage and infection. Conclusion The rectum is the predominant site for young patients with colorectal cancers. Mucinous and signet ring cell carcinoma are two major histological categories. The young patients have poor prognosis. Operation is an ideal way to treat the young patients with colorectal cancer. The extended resection with nervous retention is the most effective operation type.