梗阻性结直肠癌患者的临床病理特点及生存状况分析

Analysis of clinicopathological features and survival status of patients with obstructive colorectal cancer

目的 探讨梗阻性结直肠癌患者的临床病理特点与生存状况。方法 选择2010年1月至2015年1月濮阳市油田总医院收治的654例结直肠癌患者为研究对象,其中梗阻性结直肠癌327例,非梗阻性结直肠癌327例。采集患者的临床资料,总结梗阻性结直肠癌患者的临床病理特点与生存状况,分析结直肠癌患者发生肠梗阻的相关因素,采用logistic回归分析梗阻性结直肠癌患者死亡的危险因素。结果 肿瘤部位、肿瘤N分期、肿瘤直径、Dukes分期、组织分化程度与结直肠癌患者发生肠梗阻有关(P<0.05),而患者年龄、性别、首发症状、肿瘤T分期、肿瘤沉积、脉管癌栓或神经侵犯及肿瘤大体形态与结直肠癌患者发生肠梗阻无关(P>0.05)。术后1a,梗阻性结直肠癌患者复发率、转移率、病死率分别为6.87%(20/291)、4.81%(14/291)、11.68%(34/291),非梗阻性结直肠癌患者复发率、转移率、病死率分别为3.84%(11/286)、2.09%(6/286)、5.94%(17/286);术后3a,梗阻性结直肠癌患者复发率、转移率、病死率分别为28.52%(83/291)、14.43%(42/291)、36.08%(105/291),非梗阻性结直肠癌患者复发率、转移率、病死率分别为16.78%(48/286)、5.24%(15/286)、18.18%(52/286);梗阻性结直肠癌患者术后1、3a复发率、转移率、病死率显著高于非梗阻性结直肠癌患者(P<0.05)。溃疡型结直肠癌、Dukes分期C期、肿瘤组织低分化、腹水、复发、转移、术后无化学治疗是梗阻性结直肠癌患者死亡的危险因素(P<0.05)。结论 肿瘤部位、肿瘤N分期、组织分化程度与结直肠癌患者发生肠梗阻有关,梗阻性结直肠癌患者术后复发率、转移率和病死率较高,溃疡型结直肠癌、Dukes分期C期、肿瘤组织低分化、腹水、复发、转移、术后无化学治疗是梗阻性结直肠癌患者死亡的危险因素。

Objective To investigate the clinicopathological features and survival status of patients with obstructive colorectal cancer.Methods A total of 654 patients with colorectal cancer admitted to Puyang Oilfield General Hospital from January 2010 to January 2015 were selected as the study subjects,including 327 cases of obstructive colorectal cancer and 327 cases of non-obstructive colorectal cancer.The clinical data of the patients were collected to summarize the clinicopathological characteristics and survival status of patients with obstructive colorectal cancer,and analyze the related factors of intestinal obstruction.The risk factors of death in patients with obstructive colorectal cancer were analyzed by logistic regression.Results The tumor location,N-staging of tumors,tumor diameter,Dukes stage and histological differentiation were related to the occurrence of intestinal obstruction in patients with colorectal cancer (P<0.05).The age,sex,initial symptoms,T-staging of tumors,tumor deposition,cancer thrombus of vascular or nerve invasion,and tumor gross appearance were not related to the occurrence of intestinal obstruction in patients with colorectal cancer (P>0.05).One year after operation,the recurrence rate,metastasis rate and fatality rate of patients with obstructive colorectal cancer were 6.87%(20/291),4.81%(14/291) and 11.68%(34/291),respectively;and they were 3.84%(11/286),2.09%(6/286) and 5.94%(17/286) in patients with non-obstructive colorectal cancer,respectively.Three years after operation,the recurrence rate,metastasis rate and fatality rate of patients with obstructive colorectal cancer were 28.52%(83/291),14.43%(42/291) and 36.08%(105/291),respectively;and they were 16.78%(48/286),5.24%(15/286) and 18.18%(52/286) in patients with non-obstructive colorectal cancer,respectively.The postoperative 1- and 3-year recurrence rate,metastasis rate and fatality rate of patients with obstructive colorectal cancer were significantly higher than those in patients with non-obstructive colorectal cancer (P<0.05).Ulcerative colorectal cancer,Dukes C-staging,poor differentiation of tumor tissue,ascites,recurrence,metastasis,and no chemotherapy after operation were the risk factors for death in patients with obstructive colorectal cancer (P<0.05).Conclusions The tumor location,T-staging of tumors and tissue differentiation are related to intestinal obstruction in patients with colorectal cancer.The postoperative recurrence rate,metastasis rate and mortality rate of patients with obstructive colorectal cancer are higher.Ulcerative colorectal cancer,Dukes C-staging,poor differentiation of tumor tissue,ascites,recurrence,metastasis,and no chemotherapy after operation are the risk factors for death in patients with obstructive colorectal cancer.