左半结直肠癌并肠梗阻的外科治疗及预后分析

Surgical treatment and prognostic factors for obstructing left colorectal cancer

目的探讨左半结直肠癌并肠梗阻的外科治疗及其影响预后的因素。方法回顾性分析2001年1月至2006年12月间在青岛大学医学院附属医院行外科治疗的93例左半结直肠癌并肠梗阻患者的临床资料。结果93例患者中男53例，女40例；中位年龄61岁；其中51例合并内科疾病。行根治性切除术67例。其中一期切除吻合21例、Hartmann手术35例、Miles手术11例；行姑息性手术26例，其中单腔或双腔造瘘术14例，短路手术7例．姑息性切除5例。93例患者均获随访，1、3、5年生存率分别为94％、59％、38％。单因素和多因素预后分析显示，手术根治性、TNM分期和术前CEA水平是影响患者预后的独立因素（均P〈0．05）。结论手术根治性、TNM分期和术前CEA水平是左半结直肠癌并肠梗阻患者预后影响因素：早期诊治、根治性手术及合理地选择手术方式有助于提高患者生存率。

Objective To investigate the outcomes of surgical treatment and the prognostic factors of long-term survival for obstructing left colorectal cancer. Methods Clinicopathological and follow-up data of 93 patients with obstructing left colorectal cancer undergoing surgical treatment from January 2001 to December 2006 in the Affiliated Hospital of Medical College of Qingdao University were analyzed retrospectively. Results There were 53 males and 40 females. The median age was 61 years old. Fifty-one patients had concurrent medical condition. Radical resection was performed in 67 patients, including one-stage resection （n=21）, Hartmann procedure （n=35）, and Miles procedure （n=ll）. Surgery was palliative in 26 patients, including diverting stoma（n=14）, bypass surgery（n=7）, and palliative resection （n=5）. All the 93 patients were followed up. The 1-, 3-, and 5-year survival rates were 94%, 59%, and 38%, respectively. Univariate and multivariate analyses showed that radical resection, TNM staging, and preoperative level of carcinoembryonic antigen were independent prognostic factors （all P〈0.05）. Conclusions Radical resection, TNM stage, and preoperative CEA level are prognostic factors of obstructing left colorectal cancer. Early diagnosis, radical resection, and selection of appropriate surgical procedure are helpful to prolong survival time of patients with obstructing left colorectalcancer.