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目的:探讨不同部位直肠癌患者临床病理特征及预后生存差异。方法:回顾性分析陕西省人民医院2005年6月—2010年5月间行直肠癌根治术且资料完整的522例患者的临床资料,其中高位直肠癌(高位组)91例,中位直肠癌(中位组)168例,低位直肠癌(低位组)263例,分析比较3组间临床病理特点及生存情况。结果:高位组发病年龄最大(64.3岁),肿瘤直径最大(5.1 cm),病理分期最早,5年生存率(63.7%)居中(P<0.05);中位组与高位组在发病年龄上相似,在肿瘤大小、淋巴结转移程度、病理分期上,中位组介于高和低位组之间,5年生存率(69.6%)最高(P<0.05);与高、中位组相比,低位组发病年龄偏低(60.1岁),肿瘤直径较小,易出现淋巴结转移和远处转移,临床分期较晚,3年及5年生存率最低(P<0.05)。多因素分析显示,肿瘤部位是影响直肠癌患者预后的独立因素(P<0.05)。新辅助治疗、Miles手术可以提高低位直肠癌的3年(75.6%,74.1%)及5年生存率(48.8%,53.0%)(P<0.05),腹腔镜技术不是低位直肠癌预后的影响因素(P>0.05)。结论:不同部位直肠癌的临床病理特征及预后存在明显差异,低位直肠癌预后较差。慎重保肛、新辅助治疗对改善患者的预后可能会有积极的作用。
Objective: To investigate the clinicopathological features and prognosis of patients with rectal cancer at different sites. Methods: A retrospective analysis of Shaanxi Provincial People’s Hospital from June 2005 to May 2010 radical resection of colorectal cancer and complete data of 522 patients with clinical data, including 91 cases of high rectal cancer (high group), the median rectal cancer (Median group) 168 cases, low rectal cancer (low group) 263 cases, analysis of clinical and pathological features and survival among the three groups. Results: The highest age of the high group (64.3 years old), the largest tumor diameter (5.1 cm), the earliest pathological stage and the 5 year survival rate (63.7%) were intermediate (P <0.05) The median 5-year survival rate (69.6%) was the highest (P <0.05) in the tumor size, lymph node metastasis and pathological stage. The median The age of onset was low (60.1 years), the diameter of tumor was small, lymph node metastasis and distant metastasis were easily observed. The clinical stage was late, and the survival rates at 3 years and 5 years were the lowest (P <0.05). Multivariate analysis showed that the tumor site was an independent factor affecting the prognosis of patients with rectal cancer (P <0.05). Neoadjuvant therapy and Miles operation can improve the low-grade rectal cancer for 3 years (75.6%, 74.1%) and 5-year survival rate (48.8%, 53.0%) (P 0. 05). Laparoscopy is not the prognostic factor for low rectal cancer (P> 0.05). Conclusion: The clinicopathological features and prognosis of rectal cancer in different sites have significant differences, and the prognosis of low rectal cancer is poor. Careful protection anal, neoadjuvant therapy to improve the prognosis of patients may have a positive effect.