摘要
目的探讨姑息性手术结合125I粒子植入对Ⅳ期直肠癌的治疗效果,并分析远处转移不能根治Ⅳ期直肠癌的预后因素。方法回顾性分析1999年1月至2006年3月诊治的152例Ⅳ期直肠癌患者的临床病理资料,单因素和多因素分析评价其预后因素。结果 152例Ⅳ期直肠癌患者,119例合并有梗阻、出血或穿孔,行姑息性手术,包括原发灶姑息切除及肝转移灶切除25例,仅原发灶姑息切除66例,单纯造口术或开腹探查28例。手术治疗患者中有45例接受125I粒子植入。全组患者中位生存时间11个月。单因素分析显示,性别、年龄、浸润深度、组织分化程度、淋巴结转移与患者预后无关;原发灶切除、转移灶切除、肿瘤合并症、肿瘤转移范围、CEA水平、是否接受化疗及125I粒子植入等因素与预后相关。Cox多因素分析显示肿瘤转移范围及是否切除、CEA水平、是否接受化疗和125I粒子植入是患者的独立预后因素。结论对Ⅳ期直肠癌原发肿瘤引起的梗阻、出血或穿孔等合并症者,应争取积极手术切除,结合125I粒子植入治疗对改善患者的预后有一定疗效。
Objective To assess the efficacy of surgical treatment combined with Iodine-125 implantation for stage Ⅳ rectal carcinoma patients,and analyze the prognostic factors for incurable stage Ⅳ rectal carcinoma.Methods Clinical data of 152 patients with incurable stage Ⅳ rectal carcinoma from January 1999 to March 2006 in our hospital were analyzed retrospectively.Univariate and multivariate analyses were used to analyze prognostic factors for such patients.Results Among 152 incurable stage Ⅳ rectal carcinoma patients with distant metastasis,119 patients received palliative operations because of obstruction,bleeding or perforation complications,including palliative resection of primary tumor and hepatic metastases in 25,resection of primary tumor in 66,and colostomy or exploration alone in 28 cases.Forty-five patients received Iodine-125 implantation during palliative operation.The median survival of all these 152 patients was 11.0 months.Univariate analysis revealed that sex,age,invasion depth,tumor differentiation and lymph node metastasis were not,while resections of primary tumor and hepatic metastases,complications of primary tumor,extent of tumor spread,CEA level,chemotherapy and Iodine-125 implantation were correlated with the prognosis of the patients.Multivariate analysis revealed that extent of tumor spread,resections of metastases,CEA level,chemotherapy and Iodine-125 implantation were independent prognostic factors.Conclusions Primary tumor resection is the choice of therapy for stage Ⅳ rectal carcinoma complicated with obstruction,bleeding or perforation.Surgical treatment combined with Iodine-125 implantation can improve the prognosis.
出处
《消化肿瘤杂志（电子版）》
2011年第1期23-26,共4页
Journal of Digestive Oncology(Electronic Version)
基金
广东省自然科学基金(编号9151012001000009)
广东省科协基金(编号GDKX201001)
广东省科技计划项目(编号2010B080701088)
关键词
直肠肿瘤
姑息手术
125I粒子植入
预后
Rectal neoplasms
Palliative operation
Iodine-125 implantation
Prognosis
