【作者】 杨峰；

【导师】 陶庆松；

【作者基本信息】 东南大学 ， 外科学（专业学位）， 2024， 硕士

【摘要】 目的:分析我院2013-2020年直肠癌患者的临床生存现状,明确不同部位直肠癌是否存在临床特征的差异。探究影响接受手术治疗直肠癌患者的预后因素。方法:收集我院2013.1-2020.1.接受手术治疗的直肠癌患者,并根据研究要求收集整理患者的性别,年龄,高血压,糖尿病史,肠镜检查中肿瘤的直径,按照肿瘤下缘和齿状线距离认为d,将0≤d≤5cm,5<d≤10cm,10<d≤15cm依次分为低、中、高位直肠癌,术后病理报告中的肿瘤分期,脉管神经侵犯,淋巴结是否转移及转移数量,肿瘤T分期,肿瘤分化,Ki-67,Her2分子标志物,并电话询问患者的生存时间以计算5年生存期。随后通过SPSS工具分析,进行卡方分析及t检验计算不同部位直肠癌的临床特征差异,利用K-M法进行单因素生存分析,随后进行Cox多因素生存分析,探究直肠癌的预后因素。结果:对295例直肠癌患者进行分析,发现低位直肠癌造口率更高,住院时间更久,中位直肠癌术前易出现腹泻症状,高位直肠癌患者的病理分期更晚,肿瘤浸润深度及淋巴结转移概率更高,脉管侵犯更多(P<0.05)。对Ⅰ-Ⅱ期直肠癌进行亚组分析,发现低位直肠癌易出行神经侵犯,肿瘤侵犯更深(P<0.05)。对Ⅲ-Ⅳ期患者进行亚组分析,发现除低位造口率更高外,未发现其他统计学差异。接受手术治疗的直肠癌患者,多因素分析发现肿瘤的TNM分期,分化程度,年龄为直肠癌手术患者的不良预后因素。结论:低位直肠癌的分期一般较中高位直肠癌早。在早期直肠癌中,低位直肠癌更易发生神经转移。在接受手术的直肠癌患者中,肿瘤的TNM分期,肿瘤分化,患者年龄为其不良预后因素。更多还原

【Abstract】 Objective.This study aims to analyze the clinical survival status of rectal cancer patients at our hospital from 2013 to 2020 and investigate potential differences in clinical characteristics based on the tumor’s location.Furthermore,the study aims to identify prognostic factors that may influence the outcomes of patients who undergo surgery for rectal cancer.Methods.Rectal cancer patients who underwent surgical treatment at our hospital between 2013.1 and 2020.1 were included in the study.Data on the patients’ gender,age,history of hypertension,diabetes,and tumor diameter during colonoscopy were collected and organized based on the distance between the lower edge of the tumor and the dentate line.Rectal cancers were categorized as low,middle,and high based on this distance(0≤d≤5cm,5<d≤10cm,and 10<d≤15cm).Information on tumor stage,vascular and nerve invasion,lymph node metastasis,number of metastases,tumor T stage,tumor differentiation,Ki-67,Her2 molecular markers,and patient survival time was obtained through telephone interviews to calculate the 5-year survival rate.SPSS was used for chi-square analysis and t-tests to assess differences in clinical characteristics of rectal cancer at different locations.The K-M method was employed for single-factor survival analysis,followed by Cox multi-factor survival analysis to identify prognostic factors of rectal cancer.Results.An analysis of 295 patients with rectal cancer revealed that low-position rectal cancer is associated with a higher stoma rate and longer hospitalization time.Median-position rectal cancer often presents with diarrhea symptoms.Patients with high-position rectal cancer tend to have a later pathological stage,deeper tumor infiltration,higher probability of metastasis,and increased vascular invasion(P<0.05).Subgroup analyses showed that low rectal cancer in stage 1-2 patients is more likely to have nerve invasion and deeper tumor infiltration(P<0.05),while in stage 3-4 patients,only a higher stoma rate was significant.Factors such as TNM stage,tumor differentiation,and age were found to be prognostic indicators for patients with rectal cancer who underwent surgical treatment.Conclusion.low rectal cancer tends to be diagnosed at an earlier stage compared to middle and high rectal cancer,with a higher likelihood of nerve metastasis in early cases.Prognostic factors for patients who received surgery include tumor TNM stage,differentiation,and age.更多还原