腹腔镜下Dixon与Miles手术治疗Ⅲ期低位直肠癌的远期疗效比较及影响因素
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摘要
比较Ⅲ期低位直肠癌患者行腹腔镜下Dioxn或Miles术后的生存状况,探讨影响两种术式治疗低位直肠癌患者的临床相关因素。回顾性分析我院2009—2014年60例Ⅲ期低位直肠癌行Dioxn或Miles术患者的临床资料;调查以问卷形式进行,随访3年,进行Kaplan-Meier生存分析。腹腔镜Dixon组累计1年、2年、3年生存率分别为100%、86.2%、62.1%,平均生存在期为(31.65±1.20)个月,Miles组累计1年、2年、3年生存率分别为100%、89.5%、68.0%,平均生存在期为(32.25±1.18)个月,两组总体生存时间差异无统计学意义(P>0.05)。多因素分析显示肿瘤大小、CEA水平、淋巴结转移数、新辅助放化疗是影响Ⅲ期低位直肠癌手术方式的独立因素。对于Ⅲ期低位直肠癌采取保肛手术,术前应先行新辅助放化疗再评估,血清CEA水平、淋巴结转移数、肿瘤浸润深度、肿瘤大小可作为参考指标。对于无上述高危因素者可选择保肛术。
引文
[1]许剑民,冯青阳.低位直肠癌保肛手术术式选择及评价[J].中国实用外科杂志,2014,34(9):827-830.
[2]魏东,赵艇,蔡建,等.腹腔镜低位直肠癌内括约肌切除保肛手术的临床应用[J].腹腔镜外科杂志,2009,14:830-832.
[3]Pas MHVD,Haglind E,Cuesta MA,et al.Laparoscopic versus open surgery for rectal cancer(COLOR II):short-term outcomes of a randomised,phase 3 trial[J].Lancet Oncol,2013,14(3):210-218.
[4]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[5]Siegel RL,Miller KD,Jemal A.Cancer Statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[6]郁宝铭.低位直肠癌的诊治进展[J].中国实用外科杂志,2002,22(1):34-37.
[7]Tytherleigh MG,Mortensen NJM.Options for sphincter preservation in surgery for low rectal cancer[J].Bri J Surg,2003,90(8):922-933.
[8]Wexner SD,Rotholtz NA.Surgeon influenced variables in resectional rectal cancer surgery[J].Dis Colon Rectum,2000,43(11):1606-1627.
[9]Nelson H,Petrelli N,Carlin A,et al.Guidelines 2000 for colon and rectal cancer surgery[J].Natl Cancer Inst,2001,93(8):583-596.
[10]潘晓飞,陈本鑫,张干,等.肛提肌裂孔标志在腹腔镜直肠癌超低位保肛中的应用[J].中国现代普通外科进展,2015,18(11):860-863.
[11]茆家定,吴佩,杨光,等.超低位直肠癌保肛手术的临床疗效及生存质量分析[J].实用医学杂志,2015,31(16):2371-2374.
[12]Warschkow R,Steffen T,Thierbach J,et al.Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy.a retrospective study with bootstrap analysis[J].Ann Surg Oncol,2011,18(10):2772-2782.
[13]冯鹏才,杨金煜,唐明杰,等.进展期中低位直肠癌新辅助放化疗后肿瘤部位及手术方式对患者预后的影响[J].中国普通外科杂志,2015,24(6):895-898.
[14]Goldstein MJ,Mitchell EP.Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer[J].Cancer Investig,2005,23(4):338-351.
[15]Nazato DM,Matos LLD,Waisberg DR,et al.Prognostic value of carcinoembryonic antigen distribution in tumor tissue of colorectal carcinoma valor prognostico da distribuicao do antigeno carcinoembrionico(CEA)no tecido neoplasico do carcinoma colorretal[J].Arquivos De Gastroenterologia,2009,46(1):26-31.
[16]Yakabe T,Nakafusa Y,Sumi K,et al.Clinical signi cance of CEAand CA199 in postoperative follow-up of colorectal cancer[J].Ann Surg Oncol,2010,17:2349-2356.
[17]潘志忠,张华.结直肠癌患者淋巴结检数和淋巴结转移度的临床意义[J].循证医学,2009,9(3):155-157.
[18]Minsky BD.Adjuvant therapy for rectal cancer-the transatlantic view[J].Color Dis,2010,5(5):416-422.
[19]Jones B,Dale RG.The potential for mathematical modelling in the assessment of the radiation dose equivalent of cytotoxic chemotherapy given concomitantly with radiotherapy[J].Br J Radiol,2005,78(934):939-944.
[20]张鑫,李耀平,冯毅.中低位进展期直肠癌患者新辅助化放疗后肿瘤分期及生物学特性的改变[J].中华临床医师杂志(电子版)2013,7(19):8588-8592.
[2]魏东,赵艇,蔡建,等.腹腔镜低位直肠癌内括约肌切除保肛手术的临床应用[J].腹腔镜外科杂志,2009,14:830-832.
[3]Pas MHVD,Haglind E,Cuesta MA,et al.Laparoscopic versus open surgery for rectal cancer(COLOR II):short-term outcomes of a randomised,phase 3 trial[J].Lancet Oncol,2013,14(3):210-218.
[4]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[5]Siegel RL,Miller KD,Jemal A.Cancer Statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[6]郁宝铭.低位直肠癌的诊治进展[J].中国实用外科杂志,2002,22(1):34-37.
[7]Tytherleigh MG,Mortensen NJM.Options for sphincter preservation in surgery for low rectal cancer[J].Bri J Surg,2003,90(8):922-933.
[8]Wexner SD,Rotholtz NA.Surgeon influenced variables in resectional rectal cancer surgery[J].Dis Colon Rectum,2000,43(11):1606-1627.
[9]Nelson H,Petrelli N,Carlin A,et al.Guidelines 2000 for colon and rectal cancer surgery[J].Natl Cancer Inst,2001,93(8):583-596.
[10]潘晓飞,陈本鑫,张干,等.肛提肌裂孔标志在腹腔镜直肠癌超低位保肛中的应用[J].中国现代普通外科进展,2015,18(11):860-863.
[11]茆家定,吴佩,杨光,等.超低位直肠癌保肛手术的临床疗效及生存质量分析[J].实用医学杂志,2015,31(16):2371-2374.
[12]Warschkow R,Steffen T,Thierbach J,et al.Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy.a retrospective study with bootstrap analysis[J].Ann Surg Oncol,2011,18(10):2772-2782.
[13]冯鹏才,杨金煜,唐明杰,等.进展期中低位直肠癌新辅助放化疗后肿瘤部位及手术方式对患者预后的影响[J].中国普通外科杂志,2015,24(6):895-898.
[14]Goldstein MJ,Mitchell EP.Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer[J].Cancer Investig,2005,23(4):338-351.
[15]Nazato DM,Matos LLD,Waisberg DR,et al.Prognostic value of carcinoembryonic antigen distribution in tumor tissue of colorectal carcinoma valor prognostico da distribuicao do antigeno carcinoembrionico(CEA)no tecido neoplasico do carcinoma colorretal[J].Arquivos De Gastroenterologia,2009,46(1):26-31.
[16]Yakabe T,Nakafusa Y,Sumi K,et al.Clinical signi cance of CEAand CA199 in postoperative follow-up of colorectal cancer[J].Ann Surg Oncol,2010,17:2349-2356.
[17]潘志忠,张华.结直肠癌患者淋巴结检数和淋巴结转移度的临床意义[J].循证医学,2009,9(3):155-157.
[18]Minsky BD.Adjuvant therapy for rectal cancer-the transatlantic view[J].Color Dis,2010,5(5):416-422.
[19]Jones B,Dale RG.The potential for mathematical modelling in the assessment of the radiation dose equivalent of cytotoxic chemotherapy given concomitantly with radiotherapy[J].Br J Radiol,2005,78(934):939-944.
[20]张鑫,李耀平,冯毅.中低位进展期直肠癌患者新辅助化放疗后肿瘤分期及生物学特性的改变[J].中华临床医师杂志(电子版)2013,7(19):8588-8592.