本文選題：結(jié)直腸癌　切入點：肝轉(zhuǎn)移　出處：《吉林大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:探討結(jié)直腸癌患者臨床、病理特點與肝轉(zhuǎn)移的關(guān)系。 方法:回顧性分析了吉林大學(xué)中日聯(lián)誼醫(yī)院2006年1月-2009年12月收治的資料完整的術(shù)后病理證實的結(jié)直腸癌住院患者305例,就性別、病程、年齡、腫瘤發(fā)生部位、分化程度、浸潤深度、有無肝炎病史、有無淋巴結(jié)轉(zhuǎn)移、有無腹膜及大網(wǎng)膜轉(zhuǎn)移結(jié)節(jié)等方面對有無肝轉(zhuǎn)移進行對比分析。 結(jié)果:結(jié)直腸癌有無肝轉(zhuǎn)移患者的性別、腫瘤發(fā)生部位及是否感染乙肝病毒等方面相比均無統(tǒng)計學(xué)差異。腫瘤發(fā)展病程與結(jié)直腸癌肝轉(zhuǎn)移有關(guān),病程1年以上組的肝轉(zhuǎn)移率(67.31%)明顯高于1年以內(nèi)組(25.30%),兩者間有顯著的統(tǒng)計學(xué)差異(P0.01)。結(jié)直腸癌患者的年齡與肝轉(zhuǎn)移有關(guān),青年組較中老年組易發(fā)生肝轉(zhuǎn)移,青、中、老年組肝轉(zhuǎn)移率分別為61.54%、32.17%、30.20%。青年組與中、老年組相比有統(tǒng)計學(xué)意義(P0.05),中、老年組相比則無統(tǒng)計學(xué)意義(P0.05)。腫瘤細胞的分化程度與結(jié)直腸癌的肝轉(zhuǎn)移密切相關(guān),低分化者易出現(xiàn)肝轉(zhuǎn)移。低、中、高分化組的肝轉(zhuǎn)移率分別為57.58%、20.86%、15.79%,低分化組與中、高分化組間有顯著的統(tǒng)計學(xué)意義(P0.01),而中、高分化組間無統(tǒng)計學(xué)差異(P0.05)。腫瘤侵犯腸壁越深,肝轉(zhuǎn)移機率越高,腫瘤浸潤全層及全層以外者肝轉(zhuǎn)移率(39.74%)明顯高于浸潤肌層以內(nèi)者(10.53%),兩者相比有顯著的統(tǒng)計學(xué)差異(P0.01)。有區(qū)域淋巴結(jié)轉(zhuǎn)移的結(jié)直腸癌患者易發(fā)生肝轉(zhuǎn)移,且隨著淋巴結(jié)轉(zhuǎn)移數(shù)目的增加,肝轉(zhuǎn)移發(fā)生率亦增加,區(qū)域淋巴結(jié)轉(zhuǎn)移0枚、1~3枚、4枚或4枚以上組肝轉(zhuǎn)移率分別為21.93%、42.11%、61.90%,差異有顯著統(tǒng)計學(xué)意義(P0.01)。結(jié)直腸癌肝轉(zhuǎn)移與腹膜、大網(wǎng)膜轉(zhuǎn)移結(jié)節(jié)密切相關(guān),有腹膜、大網(wǎng)膜轉(zhuǎn)移結(jié)節(jié)組肝轉(zhuǎn)移率(75.76%)明顯高于無轉(zhuǎn)移結(jié)節(jié)組(27.21%),兩組相比有顯著統(tǒng)計學(xué)差異(P0.01)。將單因素分析中有統(tǒng)計學(xué)意義的6項(年齡、病程、分化程度、浸潤深度、淋巴結(jié)轉(zhuǎn)移、腹膜及大網(wǎng)膜轉(zhuǎn)移)行Cox多因素回歸分析,結(jié)果示腫瘤分化程度、浸潤深度、淋巴結(jié)轉(zhuǎn)移、腹膜及大網(wǎng)膜轉(zhuǎn)移結(jié)節(jié)與肝轉(zhuǎn)移有關(guān),排除了年齡、病程因素的影響。 結(jié)論:結(jié)直腸癌的肝轉(zhuǎn)移與患者性別、腫瘤發(fā)生部位及是否感染乙肝病毒無關(guān);病程1年以上、年齡小于等于35歲、病理為低分化、腫瘤浸潤腸壁全層及全層以外、有區(qū)域淋巴結(jié)轉(zhuǎn)移及有腹膜、大網(wǎng)膜轉(zhuǎn)移結(jié)節(jié)者易出現(xiàn)肝轉(zhuǎn)移。
[Abstract]:Objective: to investigate the relationship between clinical, pathological features and liver metastasis in patients with colorectal cancer. Methods: a total of 305 patients with colorectal cancer admitted from January 2006 to December 2009 in the Sino-Japanese Friendship Hospital of Jilin University were retrospectively analyzed according to sex, course of disease, age, location of tumor occurrence and degree of differentiation. The depth of infiltration, history of hepatitis, lymph node metastasis, peritoneal and omentum metastasis were compared. Results: there was no significant difference in sex, tumor location and hepatitis B virus infection in patients with colorectal cancer with or without liver metastasis. The course of tumor development was related to liver metastasis of colorectal cancer. The rate of liver metastasis in the group of disease course more than one year (67.31%) was significantly higher than that in the group of less than one year (25.30%). There was a significant difference between the two groups (P 0.01). The age of colorectal cancer patients was related to liver metastasis, and the young group was more likely to have liver metastasis than the middle and old group. The liver metastasis rates in the elderly group were 61.54 and 32.170.20.The difference between the young group and the middle age group was statistically significant (P 0.05), but there was no significant difference in the middle and old group. The differentiation of tumor cells was closely related to the liver metastasis of colorectal cancer. The liver metastasis rates of low, middle and high differentiation groups were 57.58 and 20.86 ~ 15.79, respectively. There was significant statistical significance between low differentiation group, middle differentiation group and high differentiation group, but there was no statistical difference between middle and high differentiation group (P 0.05). The higher the probability of liver metastasis was, the higher the liver metastasis rate was (39.74%) in patients with tumor invasion in the whole layer and outside the whole layer) than in those within the infiltrating muscular layer (10.53%). There was significant statistical difference between the two groups (P < 0.01). The patients with regional lymph node metastasis were more likely to have liver metastasis. With the increase of the number of lymph node metastasis, the incidence of liver metastasis also increased. The liver metastasis rate in the group of 0 regional lymph node metastasis, 3 or more were 21.9333.11 and 61.90, respectively. The difference was statistically significant (P 0.01). The liver metastasis and peritoneal membrane of colorectal cancer were significantly different. The liver metastasis rate in the group with greater omentum metastasis was significantly higher than that in the group without metastatic node (P 0.01), and there was a significant difference between the two groups (P 0.01). In univariate analysis, 6 items (age, course of disease) were significantly higher than those in the group without metastasis of greater omentum, and the rate of hepatic metastasis was significantly higher in the group with greater omentum metastasis than that in the group without metastasis of greater omentum. Cox regression analysis showed that the degree of differentiation, depth of invasion, lymph node metastasis, peritoneal and omentum metastasis were related to liver metastasis. The influence of age and course of disease was excluded. Conclusion: the liver metastasis of colorectal cancer is not related to sex, location of tumor and infection of hepatitis B virus, the course of disease is more than one year, the age is less than 35 years old, the pathology is low differentiation, the tumor infiltrates the whole layer and the whole layer of intestinal wall. Regional lymph node metastasis and peritoneal lymph node metastasis, greater omentum metastasis nodules prone to liver metastasis.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R735.3

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