【摘要】：目的:回顧性分析影響結(jié)直腸癌患者預(yù)后的相關(guān)危險(xiǎn)因素,為臨床治療方案的選擇提供理論依據(jù),以改善結(jié)直腸癌患者的生存狀況。材料與方法:本研究選取河北醫(yī)科大學(xué)第四醫(yī)院外二科自2010年1月至2010年12月行手術(shù)治療的293例結(jié)直腸癌患者為研究對象,對符合條件的患者采用病例隨訪(門診復(fù)查及電話隨訪),以患者的手術(shù)時間為隨訪起點(diǎn),截止時間為2016年10月30日或患者的死亡時間。共收集到257例病例資料,失訪率12.3%。通過收集患者的臨床參數(shù)(性別、年齡、吸煙飲酒史、腫瘤家族史、合并腸梗阻穿孔、術(shù)前貧血、合并糖尿病)、病理參數(shù)(腫瘤部位、腫瘤大小、組織學(xué)類型及分化程度、腸壁浸潤度、淋巴結(jié)轉(zhuǎn)移、遠(yuǎn)處轉(zhuǎn)移)、腫瘤標(biāo)記物(癌胚抗原、糖類抗原19-9)及治療方式(手術(shù)方式、新輔助治療、輔助治療、圍手術(shù)期輸血),建立EXCEL數(shù)據(jù)庫,運(yùn)用SPSS21.0統(tǒng)計(jì)軟件對數(shù)據(jù)庫資料進(jìn)行統(tǒng)計(jì)分析。單因素分析采用Kaplan-Meier法,多因素生存分析采用多因素Cox回歸模型進(jìn)行分析。結(jié)果:本研究共收集了257例結(jié)直腸癌患者完整資料,其中結(jié)腸癌116例,直腸癌患者141例,男性154例,女性103例,年齡:19-86歲,中位年齡:52.5歲。單因素分析發(fā)現(xiàn):術(shù)前有無貧血、組織學(xué)類型(腺癌、粘液腺癌)及分化(高分化、中分化、低分化)程度、腸壁浸潤程度(T1-2、T3-4)、淋巴結(jié)轉(zhuǎn)移(N0、N1、N2)、遠(yuǎn)處轉(zhuǎn)移(M0、M1)、癌胚抗原(5ng/ml、≤5ng/ml)、糖類抗原19-9(27U/ml、≤27U/ml)、手術(shù)方式(根治性手術(shù)、姑息性手術(shù))在結(jié)直腸癌的對比中差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步多因素分析后發(fā)現(xiàn):癌胚抗原、糖類抗原19-9、淋巴結(jié)轉(zhuǎn)移、手術(shù)方式在結(jié)直腸癌的對比中差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:癌胚抗原、淋巴結(jié)轉(zhuǎn)移、手術(shù)方式是影響結(jié)腸癌患者預(yù)后的獨(dú)立危險(xiǎn)因素;糖類抗原19-9、淋巴結(jié)轉(zhuǎn)移是影響直腸癌患者預(yù)后的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to analyze the risk factors influencing the prognosis of patients with colorectal cancer and to provide a theoretical basis for the choice of clinical treatment to improve the survival status of patients with colorectal cancer. Materials and methods: 293 patients with colorectal cancer who received surgical treatment from January 2010 to December 2010 in the second Department of the fourth Hospital of Hebei Medical University were selected as the study subjects. The eligible patients were followed up by case (outpatient review and telephone follow-up), with the patient's operative time as the starting point and the deadline of October 30, 2016 or the patient's death time as the starting point. A total of 257 cases were collected and the missing rate was 12.3%. The clinical parameters (sex, age, smoking and drinking history, family history of tumor, complicated with perforation of intestinal obstruction, preoperative anemia, diabetes mellitus), pathological parameters (tumor location, tumor size, histological type and differentiation degree) were collected. EXCEL database was established by intestinal wall invasion, lymph node metastasis, distant metastasis, tumor markers (carcinoembryonic antigen, carbohydrate antigen 19-9) and treatment (operation, neoadjuvant therapy, perioperative blood transfusion). Use SPSS21.0 statistical software to carry on the statistical analysis to the database data. Kaplan-Meier method was used for univariate analysis and multivariate Cox regression model was used for multivariate survival analysis. Results: a total of 257 patients with colorectal cancer were collected, including 116 colon cancer patients, 141 rectal cancer patients, 154 males and 103 females, with a median age of 52.5 years. Univariate analysis showed that there were anemia, histological types (adenocarcinoma, mucinous adenocarcinoma) and differentiation (high, medium and low differentiation) before operation. The degree of invasion of intestinal wall (T1-2n / T3-4), lymph node metastasis (N0 / N1N _ 2), distant metastasis (M0M _ 1), carcinoembryonic antigen (5ng / ml, 鈮，

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