青年人结直肠癌临床病理特征及外科治疗

Clinical Pathological Features and Surgical Treatment of Young Patients with Colorectal Cancer

【目的】探讨青年人结直肠癌临床特点与病理学特征。【方法】对在本院手术的98例青年结直肠癌患者的临床表现及病理资料进行回顾分析和总结。【结果】98例青年结直肠癌患者中，男72例，女26例，病变部位以直肠（35例）和乙状结肠（22例）多见，占总数58．16％（57／98）。降结肠最少4例（4．08％）。直肠癌距肛缘平均距离4．5cm．右半结肠15例，占总数15．3％。以大便习惯改变和间歇性粘液血便为主要症状。术前合并肠梗阻、肠穿孔、严重贫血等33例（33．7％）。63例（64．3％）行根治术，26例（26．5％）行姑息术。根治术、姑息术5年存活率分别为45．58％和0。病理类型以管状腺癌、黏液腺癌多见，占73．5%；Dukes分期其中C＋D期为主，56例，占57．14％。【结论】青年结直肠病人，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。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 explore the clinical features and pathological characteristics of young patients with colorectal cancer. [Methods] The clinical manifestation and pathological data of 98 young patients with colorectal cancer undergoing the surgery in our hospital were analyzed and summarized retrospectively. [Results]Among 98 young patients with colorectal cancer, there were 72 male patients and 26 female patients. The main lesion sites were rectum（35 cases） and sigmoid colon（22 cases） accounting for 58. 16% （57/98）. There were 4 patients with descending colon cancer（4.08%） which was the least. The average distance from rectal cancer to anal verge was 4.5cm. There were 15 patients with right hemicolon cancer（15.3 %）. The ma- jor symptoms were the change of bowel habit and intermittence mucus bloody stool. There were 33 patients complicated with intestinal obstruction, intestinal perforation and serious hemophthisis（33.7 %） before the op- eration. Radical excision was performed for 63 patients（64.3 %） and palliative resection was performed for 26 patients（26.5%）. The 5 year survival rate of radical excision and palliative resection was 45. 58% and 0%, respectively. The main pathological types were tubular adenocarcinoma and mucinous adenocarcinoma （73.5%）. Dukes stage C and D was seen in 56 patients（57.14%）. [Conclusion] The major lesion site is rec- tum in young patients with colorectal cancer. Poorly differentiated adenocarcinorna and signet ring cell carcino- ma are the main histological types, and easy to be metastasized and implanted, and have poor prognosis. The extended radical resection with nervous retention is the first choice and can obtain higher radical cure rate and quality of life.