中国实用外科杂志

中国实用外科杂志

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手术治疗结直肠癌腹膜转移75例预后分析

钟清华，马腾辉，王怀明，刘俊杰，黄斌杰，袁紫旭，汪建平，王    磊   

  1. 中山大学附属第六医院结直肠肛门外科，广东广州 510655
  • 出版日期:2016-11-01 发布日期:2016-10-27

  • Online:2016-11-01 Published:2016-10-27

摘要：

目的    探讨影响结直肠癌腹膜转移手术疗效的预后因素。方法    回顾性分析中山大学附属第六医院2011年1月至2015年1月行手术治疗的75例结直肠癌腹膜转移病人的临床及随访资料，分析不同手术方式病人的预后。结果    总体生存时间为18.6（11.7~25.6）个月。完全性切除、不完全性切除及减状手术（单纯造口或短路手术）病人的中位生存时间分别为38.2、10.4和10.4个月。与减状手术相比，完全性切除病人有明显生存获益（P＜0.001），而不完全性切除病人则无生存获益（P=0.524）。多因素分析示，腹膜癌指数（PCI）＜20、完全性切除及单纯性腹膜转移是预后良好的独立因素。不完全性切除与减状手术病人Clavien-Dindo分级≥Ⅱ级并发症发生率分别为22.2%和0，术后30 d病死率分别为7.4%和0。结论    接受完全性切除手术的结直肠癌腹膜转移病人的预后较好；与减状手术相比，不完全性切除并不能改善病人预后。

关键词: 结直肠肿瘤, 腹膜转移, 预后分析

Abstract:

Surgical intervention and prognostic factor analysis of colorectal peritoneal carcinomatosis: A retrospective analysis of 75 consecutive cases        ZHONG Qing-hua，MA Teng-hui，WANG Huai-ming，et al. Department of Colorectal Surgery，the Sixth Affiliated Hospital of Sun Yat-Sen University，Guangzhou 510655，China
Corresponding author：WANG Lei，E-mail: wangl9@mail.sysu.edu.cn
Abstract    Objective    To explore risk factors associated with survival for patients who underwent surgery for colorectal peritoneal carcinomatosis. Methods    The clinical and follow-up data of 75 patients who underwent surgery for colorectal peritoneal carcinomatosis at the Sixth Affiliated Hospital of Sun Yat-Sen University from January 2011 to January 2015 were analyzed retrospectively. The influence of surgery on the prognosis was evaluated. Results    The overall median survival time was 18.6 months. The median survival time of the complete cytoreduction group，the incomplete cytoreduction and the palliative surgery group (diversion only or bypass surgery) were 38.2，10.4 and 10.4 months, respectively; compared with the palliative surgery group，the complete cytoreduction had significant survival benefit (P＜0.001)，whereas the incomplete cytoreduction had not (P=0.524).  The results of multivariate analysis demonstrated that PCI＜20，complete cytoreduction and peritoneal carcinomatosis alone were independent good prognostic factors. Complication incidence (Clavien-Dindo ≥ 2) of the incomplete cytoreduction group and the palliative surgery group were 22.2% and 0 respectively; 30-day mortality were 7.4% and 0. Conclusion    Patients performed complete cytoreduction have a relative good prognosis. Compared with palliative surgery，incomplete cytoreduction fails to improve patient prognosis.

Key words: colorectal neoplasm, peritoneal carcinomatosis, prognostic factor analysis