早期大肠癌内镜治疗5年生存情况及中药干预作用研究
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摘要
目的观察内镜治疗早期大肠癌的远期疗效及再发相关因素的影响,探讨中药干预作用。方法回顾性分析2009年1月-2013年2月南京中医药大学附属医院消化内镜中心经内镜黏膜切除术或黏膜下剥离术治疗的早期大肠癌患者50例。治疗组30例术后服用健脾化瘀汤,对照组20例未予其他干预。统计患者5年生存率、复发率、再发率,比较2组再发情况,分析不同病变部位、病理类型、腺瘤数目、浸润深度患者的再发情况。结果 50例患者5年生存率为100.00%,复发率为0,再发率为16.00%(8/50)。治疗组再发率为6.67%(2/30),对照组为35.00%(7/20),2组比较差异有统计学意义(P<0.05)。大肠癌病理类型、腺瘤数目、浸润深度是再发的重要影响因素。结论内镜治疗早期大肠癌的5年远期疗效显著,绒毛状腺瘤癌变、多发腺瘤、深度浸润至黏膜下层是早期大肠癌内镜术后再发的重要影响因素,中药干预可降低内镜术后早期大肠癌再发率。
Objective To observe the long-term efficacy of endoscopic treatment of early colorectal cancer and factors associated with recurrence; To discuss the effects of TCM intervention. Methods A retrospective study was performed on 50 patients with early colorectal cancer who underwent endoscopic mucosal resection or submucosal dissection at the Digestive Endoscopy Center of Affiliated Hospital of Nanjing University of Chinese Medicine from January 2009 to February 2013. The patients were divided into treatment group(30 cases) and control group(20 cases). The treatment group took Jianpi Huayu Decoction. The control group did not took intervention. The 5-year survival rate, local recurrent rate, and recurrence rate of patients of both groups were compared. The recurrence of patients with different lesions, pathological types, adenomas number, and depth of invasion were analyzed.Results The 5-year survival rate of 50 patients was 100.00%, and the local recurrent rate was 0, and the recurrence rate was 16.00%(8/50). The recurrence rate was 6.67%(2/30) in the treatment group and 35%(7/20) in the control group, with statistical significance(P<0.05). Pathological type, number of adenomas, and depth of invasion were important factors in recurrence. Conclusion Endoscopic treatment of early colorectal cancer has a good long-term efficacy of 5 years. Villous adenoma carcinogenesis, multiple adenoma and deep infiltration to submucosa are the important factors influencing the recurrence after endoscopic surgery of early colorectal cancer. TCM intervention can reduce the recurrence rate of early colorectal cancer after endoscopic surgery.
Objective To observe the long-term efficacy of endoscopic treatment of early colorectal cancer and factors associated with recurrence; To discuss the effects of TCM intervention. Methods A retrospective study was performed on 50 patients with early colorectal cancer who underwent endoscopic mucosal resection or submucosal dissection at the Digestive Endoscopy Center of Affiliated Hospital of Nanjing University of Chinese Medicine from January 2009 to February 2013. The patients were divided into treatment group(30 cases) and control group(20 cases). The treatment group took Jianpi Huayu Decoction. The control group did not took intervention. The 5-year survival rate, local recurrent rate, and recurrence rate of patients of both groups were compared. The recurrence of patients with different lesions, pathological types, adenomas number, and depth of invasion were analyzed.Results The 5-year survival rate of 50 patients was 100.00%, and the local recurrent rate was 0, and the recurrence rate was 16.00%(8/50). The recurrence rate was 6.67%(2/30) in the treatment group and 35%(7/20) in the control group, with statistical significance(P<0.05). Pathological type, number of adenomas, and depth of invasion were important factors in recurrence. Conclusion Endoscopic treatment of early colorectal cancer has a good long-term efficacy of 5 years. Villous adenoma carcinogenesis, multiple adenoma and deep infiltration to submucosa are the important factors influencing the recurrence after endoscopic surgery of early colorectal cancer. TCM intervention can reduce the recurrence rate of early colorectal cancer after endoscopic surgery.
引文
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[2] DESANTIS C E, LIN C C, MARIOTTO A B, et al. Cancer treatment andsurvivorshipstatistics,2014[J].CACancerJClin,2014,64(4):252-271.
[3]柏愚,杨帆,马丹,等.中国早期结直肠癌筛查及内镜诊治指南(2014年,北京)[J].胃肠病学,2015,20(6):345-365.
[4]房静远,时永全,陈萦晅,等.中国结直肠癌预防共识意见(2016年,上海)[J].胃肠病学,2016,21(11):668-686.
[5]国家中医药管理局.24个专业105个病种中医诊疗方案[M].北京,2012:443-446.
[6]郭丽艳,苗华.内镜黏膜下层剥离术治疗早期大肠癌及高级别上皮内瘤变效果分析[J].现代实用医学,2018,30(5):670-672.
[7]郑江江,朱音,李昌水,等.肿瘤相关成纤维细胞CD10表达在结直肠腺瘤癌变和复发中的意义[J].浙江大学学报:医学版,2016,45(4):335-341.
[8]潘琳娜,张志燕,赵洪清.结直肠息肉与结直肠癌的演变特性分析[J].中华内科杂志,1999,38(4):255.
[9]张慧,曹海龙,王邦茂.内镜下切除结直肠高危腺瘤随访166例[J].世界华人消化杂志,2011,19(24):2593-2596.
[10]张小琴,贺亚敏.健脾化瘀汤对内镜下大肠腺瘤切除术后复发的影响[J].国际中医中药杂志,2016,38(10):877-879.