發(fā)布時間：2018-02-06 06:59

  本文關鍵詞： 左側(cè)結(jié)腸癌 右側(cè)結(jié)腸癌 臨床特征 對比分析 預后　出處：《蘭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本文通過回顧性分析160例結(jié)腸癌患者的臨床病歷資料,對比研究左、右側(cè)結(jié)腸癌患者的臨床特征及預后,為今后進一步研究左、右側(cè)結(jié)腸癌的發(fā)病機制及臨床上在結(jié)腸癌的診斷、治療、預后方面提供數(shù)據(jù)資料。方法:收集自2012年06月~2016年10月于蘭州大學第一醫(yī)院收治的新發(fā)結(jié)腸癌患者的住院病歷資料,共160例(左側(cè)結(jié)腸癌66例,右側(cè)結(jié)腸癌94例),研究分析其年齡、性別、個人史、家族史、體重指數(shù)、首發(fā)癥狀及體征、血常規(guī)、血脂、腫瘤標記物、影像學檢查、腫瘤部位、浸潤深度、病理類型、分化程度、轉(zhuǎn)移情況、大體分型、Dukes’分期、預后等指標,并做以比較分析。所有數(shù)據(jù)使用Excel表整理并采用SPSS 21.0統(tǒng)計軟件包進行統(tǒng)計研究分析。結(jié)果:1.160例結(jié)腸癌患者中,相比左側(cè)結(jié)腸癌,右側(cè)結(jié)腸癌患者平均發(fā)病年齡較高(62.78±12.11 vs 56.02±14.52),將患者發(fā)病年齡進行分組,得出左、右側(cè)結(jié)腸癌患者發(fā)病年齡的差異以40歲 70歲之間最明顯(84.85%vs65.96%);左、右側(cè)結(jié)腸癌患者與性別之間的差異無統(tǒng)計學意義(P0.05),在男性、女性分組中,均為右側(cè)結(jié)腸癌發(fā)病率高于左側(cè),差異具有統(tǒng)計學意義(P0.05);2.左側(cè)結(jié)腸癌中主要臨床首發(fā)癥狀為排便習慣及糞便形狀改變(75.76%),右側(cè)結(jié)腸癌患者中主要臨床首發(fā)癥狀為不明原因貧血或體重下降(60.63%)、腹部包塊(25.53%),左側(cè)結(jié)腸癌患者肥胖例數(shù)高于右側(cè)(7.57%vs 2.13%);腫瘤標記物CEA與CA199檢測的陽性率右側(cè)均高于左側(cè),差異具有統(tǒng)計學意義(P0.05);3.相比左側(cè)結(jié)腸癌,右側(cè)結(jié)腸癌以隆起型(46.80%vs 40.91%)、潰瘍型(26.60%vs 13.64%)、低分化腺癌(26.60%vs 22.73%)為主,差異具有統(tǒng)計學意義(P0.05);4.左、右側(cè)結(jié)腸癌患者在腫瘤直徑、TNM分期以及血脂代謝方面的差異均無統(tǒng)計學意義(P0.05);5.相比左側(cè)結(jié)腸癌,右側(cè)結(jié)腸癌更易發(fā)生淋巴轉(zhuǎn)移(51.06%vs 34.85%)、肝臟轉(zhuǎn)移(14.89%vs 4.55%),差異具有統(tǒng)計學意義(P0.05);6.分析血脂與結(jié)腸癌TNM分期之間的相關性中,得出兩者呈負相關關系;對左、右側(cè)結(jié)腸癌患者進行預后分析得出,相比右側(cè)結(jié)腸癌,左側(cè)結(jié)腸癌患者3年累計生存率偏高,差異具有統(tǒng)計學意義(P0.05);7.經(jīng)COX比例風險模型分析得出,性別、腫瘤部位、肝轉(zhuǎn)移是影響結(jié)腸癌預后的主要影響因素。結(jié)論:同左側(cè)結(jié)腸癌相比較,右側(cè)結(jié)腸癌患者發(fā)病平均年齡高,主要臨床首發(fā)癥狀不典型,發(fā)生貧血、體重下降的比例高,分化程度低,主要以潰瘍型與隆起性為主,更易發(fā)生淋巴結(jié)轉(zhuǎn)移與肝轉(zhuǎn)移,3年累計生存率低,同時分析得出性別、腫瘤部位、肝轉(zhuǎn)移是影響結(jié)腸癌預后的主要影響因素。
[Abstract]:Objective: to analyze the clinical data of 160 patients with colon cancer retrospectively, and to compare the clinical features and prognosis of patients with left and right colon cancer, so as to further study the left side in the future. The pathogenesis of right colon cancer and its clinical diagnosis and treatment. Methods: from June 2012 to October 2016, we collected the medical records of newly diagnosed colon cancer patients in the first Hospital of Lanzhou University. The age, sex, personal history, family history, body mass index, initial symptoms and signs, blood routine examination, blood lipid and tumor markers were analyzed in 160 cases (66 cases of left colon cancer and 94 cases of right colon cancer). Imaging examination, tumor location, depth of invasion, pathological type, differentiation, metastasis, gross classification and Dukes' staging, prognosis and other indicators. All the data were collected by Excel table and analyzed by SPSS 21.0 software package. Results among 1.160 colon cancer patients. Compared with left colon cancer, the average onset age of patients with right colon cancer was 62.78 鹵12.11 vs 56.02 鹵14.52. The difference of onset age in patients with right colon cancer was the most obvious between 40 and 70 years of age, including 84.85 vs 65.96; There was no significant difference between the left and right colon cancer patients and gender. In both male and female groups, the incidence of right colon cancer was higher than that in the left. The difference was statistically significant (P 0.05). 2. The main clinical symptoms of left colon cancer were defecation habit and stool shape change (75.76). The main clinical symptoms of patients with right colon cancer were anemia of unknown cause or weight loss of 60.63 and abdominal mass of 25.53). The number of obese patients in the left colon cancer patients was higher than that in the right side (7.57 vs 2.13). The positive rates of CEA and CA199 in the right side were higher than those in the left, and the difference was statistically significant (P 0.05). 3.Compared with the left colon cancer, the right colon cancer with bulge type 46.80 vs 40.91, ulcer type 26.60 vs 13.64). Low differentiated adenocarcinoma (26.60 vs 22.73), the difference was statistically significant (P 0.05). 4. There was no significant difference in tumor diameter TNM stage and lipid metabolism between left and right colon cancer patients (P 0.05). 5. Compared with the left colon cancer, the right colon cancer is more likely to develop lymphatic metastases (51.06 vs 34.85), and the liver metastasis is 14.89 vs 4.55). The difference was statistically significant (P 0.05). 6. Analyzing the correlation between blood lipid and TNM stage of colon cancer, we found that there was a negative correlation between the blood lipids and the TNM stage of colon cancer. Compared with the right colon cancer, the 3-year cumulative survival rate of the left colon cancer patients was higher than that of the right colon cancer patients, and the difference was statistically significant (P 0.05). 7. COX proportional risk model showed that sex, tumor location and liver metastasis were the main factors affecting the prognosis of colon cancer. Conclusion: compared with the left colon cancer. The average age of right colon cancer patients is high, the main clinical initial symptoms are atypical, anemia, the proportion of weight loss is high, differentiation is low, mainly ulcer type and protuberance. Lymph node metastasis and liver metastasis were more likely to occur, and the 3-year cumulative survival rate was low. At the same time, sex, tumor location and liver metastasis were the main factors influencing the prognosis of colon cancer.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.35

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