160例左、右侧结肠癌的临床特征及预后分析

发布时间：2018-02-06 06:59

本文关键词： 左侧结肠癌右侧结肠癌临床特征对比分析预后　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文通过回顾性分析160例结肠癌患者的临床病历资料,对比研究左、右侧结肠癌患者的临床特征及预后,为今后进一步研究左、右侧结肠癌的发病机制及临床上在结肠癌的诊断、治疗、预后方面提供数据资料。方法:收集自2012年06月~2016年10月于兰州大学第一医院收治的新发结肠癌患者的住院病历资料,共160例(左侧结肠癌66例,右侧结肠癌94例),研究分析其年龄、性别、个人史、家族史、体重指数、首发症状及体征、血常规、血脂、肿瘤标记物、影像学检查、肿瘤部位、浸润深度、病理类型、分化程度、转移情况、大体分型、Dukes’分期、预后等指标,并做以比较分析。所有数据使用Excel表整理并采用SPSS 21.0统计软件包进行统计研究分析。结果:1.160例结肠癌患者中,相比左侧结肠癌,右侧结肠癌患者平均发病年龄较高(62.78±12.11 vs 56.02±14.52),将患者发病年龄进行分组,得出左、右侧结肠癌患者发病年龄的差异以40岁 70岁之间最明显(84.85%vs65.96%);左、右侧结肠癌患者与性别之间的差异无统计学意义(P0.05),在男性、女性分组中,均为右侧结肠癌发病率高于左侧,差异具有统计学意义(P0.05);2.左侧结肠癌中主要临床首发症状为排便习惯及粪便形状改变(75.76%),右侧结肠癌患者中主要临床首发症状为不明原因贫血或体重下降(60.63%)、腹部包块(25.53%),左侧结肠癌患者肥胖例数高于右侧(7.57%vs 2.13%);肿瘤标记物CEA与CA199检测的阳性率右侧均高于左侧,差异具有统计学意义(P0.05);3.相比左侧结肠癌,右侧结肠癌以隆起型(46.80%vs 40.91%)、溃疡型(26.60%vs 13.64%)、低分化腺癌(26.60%vs 22.73%)为主,差异具有统计学意义(P0.05);4.左、右侧结肠癌患者在肿瘤直径、TNM分期以及血脂代谢方面的差异均无统计学意义(P0.05);5.相比左侧结肠癌,右侧结肠癌更易发生淋巴转移(51.06%vs 34.85%)、肝脏转移(14.89%vs 4.55%),差异具有统计学意义(P0.05);6.分析血脂与结肠癌TNM分期之间的相关性中,得出两者呈负相关关系;对左、右侧结肠癌患者进行预后分析得出,相比右侧结肠癌,左侧结肠癌患者3年累计生存率偏高,差异具有统计学意义(P0.05);7.经COX比例风险模型分析得出,性别、肿瘤部位、肝转移是影响结肠癌预后的主要影响因素。结论:同左侧结肠癌相比较,右侧结肠癌患者发病平均年龄高,主要临床首发症状不典型,发生贫血、体重下降的比例高,分化程度低,主要以溃疡型与隆起性为主,更易发生淋巴结转移与肝转移,3年累计生存率低,同时分析得出性别、肿瘤部位、肝转移是影响结肠癌预后的主要影响因素。
[Abstract]:Objective: to analyze the clinical data of 160 patients with colon cancer retrospectively, and to compare the clinical features and prognosis of patients with left and right colon cancer, so as to further study the left side in the future. The pathogenesis of right colon cancer and its clinical diagnosis and treatment. Methods: from June 2012 to October 2016, we collected the medical records of newly diagnosed colon cancer patients in the first Hospital of Lanzhou University. The age, sex, personal history, family history, body mass index, initial symptoms and signs, blood routine examination, blood lipid and tumor markers were analyzed in 160 cases (66 cases of left colon cancer and 94 cases of right colon cancer). Imaging examination, tumor location, depth of invasion, pathological type, differentiation, metastasis, gross classification and Dukes' staging, prognosis and other indicators. All the data were collected by Excel table and analyzed by SPSS 21.0 software package. Results among 1.160 colon cancer patients. Compared with left colon cancer, the average onset age of patients with right colon cancer was 62.78 卤12.11 vs 56.02 卤14.52. The difference of onset age in patients with right colon cancer was the most obvious between 40 and 70 years of age, including 84.85 vs 65.96; There was no significant difference between the left and right colon cancer patients and gender. In both male and female groups, the incidence of right colon cancer was higher than that in the left. The difference was statistically significant (P 0.05). 2. The main clinical symptoms of left colon cancer were defecation habit and stool shape change (75.76). The main clinical symptoms of patients with right colon cancer were anemia of unknown cause or weight loss of 60.63 and abdominal mass of 25.53). The number of obese patients in the left colon cancer patients was higher than that in the right side (7.57 vs 2.13). The positive rates of CEA and CA199 in the right side were higher than those in the left, and the difference was statistically significant (P 0.05). 3.Compared with the left colon cancer, the right colon cancer with bulge type 46.80 vs 40.91, ulcer type 26.60 vs 13.64). Low differentiated adenocarcinoma (26.60 vs 22.73), the difference was statistically significant (P 0.05). 4. There was no significant difference in tumor diameter TNM stage and lipid metabolism between left and right colon cancer patients (P 0.05). 5. Compared with the left colon cancer, the right colon cancer is more likely to develop lymphatic metastases (51.06 vs 34.85), and the liver metastasis is 14.89 vs 4.55). The difference was statistically significant (P 0.05). 6. Analyzing the correlation between blood lipid and TNM stage of colon cancer, we found that there was a negative correlation between the blood lipids and the TNM stage of colon cancer. Compared with the right colon cancer, the 3-year cumulative survival rate of the left colon cancer patients was higher than that of the right colon cancer patients, and the difference was statistically significant (P 0.05). 7. COX proportional risk model showed that sex, tumor location and liver metastasis were the main factors affecting the prognosis of colon cancer. Conclusion: compared with the left colon cancer. The average age of right colon cancer patients is high, the main clinical initial symptoms are atypical, anemia, the proportion of weight loss is high, differentiation is low, mainly ulcer type and protuberance. Lymph node metastasis and liver metastasis were more likely to occur, and the 3-year cumulative survival rate was low. At the same time, sex, tumor location and liver metastasis were the main factors influencing the prognosis of colon cancer.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

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