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目的研究全直肠系膜切除和术前治疗对直肠癌局部复发的影响。方法2000年1月至2004年8月间接受全直肠系膜切除手术的161例直肠癌患者作为研究组;1996年1月至1999年12月间接受直肠癌手术的173例患者作为对照组。收集两组患者的临床病理和随访资料,比较其手术并发症、局部复发情况的差异。结果两组患者手术并发症发生率比较(P>0.05),差异无统计学意义。研究组肿瘤局部复发率为2.5%,低于对照组的8.0%(χ2=5.144;P=0.023)。研究组中57例接受术前治疗,肿瘤局部复发率为1.8%;而没有接受术前治疗患者的肿瘤局部复发率为3.0%(χ2=1.781,P=0.182);差异无统计学意义。将患者性别、年龄、手术方式、全直肠系膜切除与否、接受术前治疗与否、肿瘤大体类型、分化程度、分期、脉管癌栓、辅助化疗等因素作为协变量,以肿瘤局部复发作为因变量行Logistic回归分析。结果显示全直肠系膜切除和脉管癌栓是影响直肠癌局部复发的主要因素。结论全直肠系膜切除和脉管癌栓有无是影响直肠癌局部复发的主要因素。
Objective To investigate the effect of total mesorectal excision and preoperative treatment on the local recurrence of rectal cancer. Methods A total of 161 rectal cancer patients undergoing total mesorectal excision between January 2000 and August 2004 were included in the study. 173 patients undergoing rectal cancer surgery between January 1996 and December 1999 were selected as the control group. The clinical pathology and follow-up data of two groups were collected to compare the difference of surgical complications and local recurrence. Results There was no significant difference in the incidence of surgical complications between the two groups (P> 0.05). The study group tumor recurrence rate was 2.5%, lower than the control group 8.0% (χ2 = 5.144; P = 0.023). In the study group, 57 cases received preoperative treatment and the local recurrence rate was 1.8%. The local recurrence rate was 3.0% (χ2 = 1.781, P = 0.182) in patients without preoperative treatment. There was no significant difference between the two groups. The patient’s sex, age, operation mode, total mesorectal excision or not, preoperative treatment or not, the general type of tumor, degree of differentiation, staging, vascular thrombosis, adjuvant chemotherapy and other factors as covariates, with local tumor recurrence as Logistic regression analysis of dependent variable. The results show that total mesorectal excision and vascular thrombosis are the main factors affecting the local recurrence of rectal cancer. Conclusions Total mesorectal excision and vascular tumor thrombus are the main factors affecting the local recurrence of rectal cancer.