直腸癌根治術后肝轉移的影響因素分析

[摘要] 目的 總結各種病理因素和術后肝轉移之間的關系，為今后的康復與隨訪提供實證性參照。 方法 選取筆者所在醫院從2002年2月～2012年1月185例直腸癌根治術患者作為臨床研究對象，詳細回顧患者病歷，并采用門診復查、信件了解情況和電話訪問結合的方式進行隨訪。考察直腸癌根治術后肝轉移的影響因素。 結果 185例患者中肝轉移20例，無肝轉移165例，轉移率為10.8%。肝轉移與否與Dukes分期與有無淋巴結轉移有顯著相關，差異有統計學意義（P<0.05）。 結論 Dukes分期和淋巴結轉移是直腸癌根治術后肝轉移的危險因素，并且可排除年齡、性別、腫瘤大小等因素的無關性。因此對患者圍手術期的治療與護理，術后的隨訪和康復都有重大意義，可以改善患者預后。

[關鍵詞] 直腸癌；肝轉移；影響因素

[中圖分類號] R656.9 [文獻標識碼] B [文章編號] 2095-0616（2012）22-215-02

Influence factors analysis of liver metastasis after rectal carcinoma resection

LI Weixing

Department of the Second Surgery，People's Hospital of Yuexi County，Yuexi 246600，China

[Abstract] Objective To provide empirical reference to the future recovery and follow-up by summarized the relationship between all kinds of pathological factors and postoperative liver metastasis. Methods 185 cases of patients with radical resection of rectal carcinoma in the author's hospital from February 2002 to January 2012 were selected as objects and their medical records were analyzed retrospectively，they were followed up by out-patient review，letters or telephone to investigate the influence factors to postoperative liver metastasis of radical resection of rectal carcinoma. Results 20 cases of patients with liver metastasis and 165 cases without liver metastasis，metastasis rate was 10.8%.Liver metastasis was closely correlated with dukes stage and lymph node metastasis，the difference was statistically significant（P<0.05）. Conclusion Dukes stage and lymph node metastasis is dangerous factors to postoperative liver metastasis of radical resection of rectal carcinoma，and it is not correlated with age，sex and tumor size.So the treatment and nursing between peri-operation，follow-up and postoperative recovery have major implications，they could help to improve their prognosis.

[Key words] Rectal carcinoma；Liver metastasis；Influence factors

由于社會環境和人們飲食結構的改變，結直腸癌（colorectal cancer，CRC）的發病率有呈現上升趨勢。其發病率與死亡率已經升至惡性腫瘤的第三位，并且以每年4%的速度在增加[1]。患者自然生存時間約在3～17個月，肝轉移灶切除后的5年生存率為30%～50%[2]。筆者對從2002年2月～2012年1月185例直腸癌根治術患者進行病歷回顧分析，總結各種病理因素和術后肝轉移之間的關系，為今后的康復與隨訪提供實證性參照，現報道如下。

1 資料與方法

1.1 一般資料

選取筆者所在醫院2002年2月～2012年1月185例直腸癌根治術患者作為臨床研究對象，所有患者病例均完整，均為根治性手術。其中男106例，女79例；年齡25～82歲，平均（66.1±5.9）歲；Dukes分期：A期46例，B期71例，C期68例；……