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目的探讨Ⅰ期直肠癌直肠全系膜切除术后患者的临床病理特征及与长期预后的关系。方法选取接受全直肠系膜切除术并经病理学证实为p T1-2N0直肠腺癌患者共442例,对无局部复发生存、无远处转移生存、无病生存和总生存率进行分析,并应用单因素和多因素分析的方法分析影响上述远期预后指标的临床病理因素。结果全组病例中位随访时间为58个月。5年的无局部复发生存、无远处转移生存、无病生存和总生存率分别为97.6%、90.3%、89.2%、92.7%。单因素分析显示,肛门5cm以内是术后局部复发的影响因素(P=0.003),清扫<17枚淋巴结是无远处转移生存和无病生存的影响因素(P=0.026、0.033)。Cox比例危险回归模型多因素分析显示,清扫<17枚淋巴结是预后的独立影响因素。结论直肠癌直肠全系膜切除术后Ⅰ期患者可以达到良好的长期预后。淋巴结清扫数目影响预后。
Objective To investigate the clinicopathological characteristics of patients with stage Ⅰ rectal cancer after total mesorectal excision and its relationship with long-term prognosis. Methods A total of 442 patients who underwent total mesorectal excision and confirmed by pathology were patients with T1-2N0 rectal adenocarcinoma, and no recurrence, distant metastasis, disease-free survival and overall survival were analyzed. Univariate and multivariate analyzes were used to analyze the clinicopathological factors influencing the long-term prognosis. Results The median follow-up time was 58 months in all patients. Five years of no local recurrence, no distant metastasis, disease-free survival and overall survival were 97.6%, 90.3%, 89.2%, 92.7%. Univariate analysis showed that within 5 cm of the anus was the influencing factor of local recurrence (P = 0.003). Swelling of <17 lymph nodes was the influential factor of distant metastasis and disease-free survival (P = 0.026,0.033). Cox proportional hazard regression model multivariate analysis showed that cleaning <17 lymph nodes is an independent prognostic factor. Conclusions Stage I patients with rectal cancer and total mesorectal excision can achieve good long-term prognosis. The number of lymph node dissections affects the prognosis.