摘要
目的:探讨影响局部复发直肠癌(LRRC)肿瘤手术根治性和预后的相关因素。方法:采用回顾性病例对照研究。回顾性分析2009年1月至2019年8月北京大学第一医院手术治疗的LRRC患者病例资料。术前根据患者的影像检查结果对盆壁的累及情况行"北大医院F分型",即将骨盆划分为前方、两侧盆壁和骶骨4个方向,根据盆壁累及程度分为F0(无累及盆壁,肿瘤累及临近脏器或向前方侵犯泌尿、生殖器官或小肠)、F1(肿瘤累及一个方向的盆壁,如骶骨、两侧盆壁之一)、F2(累及两个方向的盆壁)和F3(累及3个方向的盆壁)。病例纳入标准:(1)经影像学及活检病理学检查(穿刺或肠镜活检)确诊为直肠癌术后局部复发;(2)随访资料和临床资料完整;(3)获得患者的知情同意书。排除因心肺等功能不全无法耐受手术治疗、影像学检查结果提示为F3或有远处转移的患者。根据病理结果对肿瘤的手术根治性进行评价。患者术后每12个月进行随访。影响肿瘤根治性的单因素风险分析采用χ^2检验,多因素风险分析采用Logistic分析。采用Kaplan-Meier法计算生存率并绘制生存曲线,生存率的比较采用Log-rank检验。应用Cox比例风险模型对于预后进行多因素回归分析。结果:共计入组111例LRRC患者,其中男性59例,女性52例,复发年龄≥65岁者36例,癌胚抗原水平≥15μg/L者48例。根据"北大医院F分型"结果,F0、F1和F2患者分别有70例、38例和3例。行腹会阴联合切除术28例,后盆腔脏器切除术32例,全盆腔脏器切除术51例(其中联合骶尾骨切除1例)。根据术后病理评价,R0、R1和R2切除分别为83例、20例和8例。单因素分析提示,LRRC的手术根治性与LRRC手术方式、北大医院F分型以及淋巴结是否转移密切相关(均P<0.05)。多因素分析提示,北大医院F分型为F1~2是不能完成R0切除的独立危险因素(OR=37.256,95%CI:8.572~161.912,P<0.001)。全组手术并发�
Objective To evaluate the factors affecting the degree of radical resection and the prognosis of patients with locally recurrent rectal cancer(LRRC).Methods A retrospective case-control study was performed.Clinical data of 111 patients with LRRC undergoing operation at the General Surgery Department of Peking University First Hospital from January 2009 to August 2019 were analyzed retrospectively.The"Peking University First Hospital F typing"was performed according to the preoperative images of the pelvic involvement.The pelvis was assigned into four directions:the front wall,lateral sides of the pelvic wall and the sacrum.According to the degree of pelvic wall involvement,F typing included F0 type(no involvement of the pelvic wall,the cancer only involved the adjacent organs or invaded conteriorly the urinary tract,genital organs or small intestine),F1 type(cancer involved the pelvic wall in one direction,such as the sacrum,or one side of the pelvic wall),F2 type(cancer involved the pelvic wall in two directions)and F3 type(cancer involved the pelvic wall in three directions).Case inclusion criteria:(1)LRRC was confirmed by imaging and pathological examination of samples(puncture or endoscopic biopsy);(2)complete clinical and follow-up data;(3)informed consent of patient.Those with dysfunction of heart,lung,etc.,intolerance of operation,F3 type indicated by image,and distant metastasis were excluded.The degree of radical resection was evaluated according to the postoperative pathological results.Patients were followed up every 12 months and related examinations were arranged.The univariate analysis of radical resection was performed byχ^2 test,and the multivariate analysis was performed by logistic methods.The survival rate was calculated by Kaplan-Meier method and the survival curve was drawn.The survival rate was compared by log-rank test.Cox proportional hazards model was used to analyze the factors affecting the prognosis of patients with LRRC.Results A total of 111 patients were included in this study.Of 1
作者
张峻岭
吴涛
陈国卫
王鹏远
姜勇
汤坚强
武颖超
潘义生
刘玉村
万远廉
汪欣
Zhang Junling;Wu Tao;Chen Guowei;Wang Pengyuan;Jiang Yong;Tang Jianqiang;Wu Yingchao;Pan Yisheng;Liu Yucun;Wan Yuanlian;Wang Xin(Department of General Surgery,Peking University First Hospital,Beijing 100034,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2020年第5期472-479,共8页
Chinese Journal of Gastrointestinal Surgery
基金
北京市中医药科技发展资金项目(JJ2018-05)
深圳市三名工程
北京大学第一医院青年临床研究专项基金(2018CR23)
北京大学第一医院科研种子基金(2018SF090)
北京大学医学部青年培育基金(BMU2020PYB026)。
关键词
直肠肿瘤
局部复发
全盆腔脏器切除
多学科会诊
根治性切除
Rectal neoplasms
Local recurrence
Total pelvic exenteration
Multi-disciplinary treatment
Curative resection
