结肠癌术后随访的价值及其影响复发的因素分析

发布时间：2018-03-25 03:38

  本文选题：结肠镜　切入点：结肠癌　出处：《青岛大学》2017年硕士论文

【摘要】：目的:通过对结肠癌患者进行根治术后定期结肠镜检查随访,利于早期发现术后的复发病灶以及结肠息肉等结肠病变,探讨定期结肠镜随访检查和镜下对症治疗对降低结肠癌复发率、提高术后生存率的临床意义;并对所有患者的临床病理特征及可能会影响结肠癌术后复发的多种因素进行分析,探讨影响结肠癌患者术后生存预后的因素。方法:对潍坊市人民医院2013年12月~2014年12月收治的共445例已行结肠癌根治术(包括结肠镜手术和开腹手术患者)且有组织病理学诊断为结肠癌的患者进行定期结肠镜随访检查,包括升结肠癌130例,横结肠癌70例,降结肠癌95例,乙状结肠癌150例。收集所有患者住院期间的临床病理资料,包括性别、年龄、原发肿瘤的部位、原发肿瘤的组织学类型及TNM分期、分化程度、淋巴结转移情况、以及术前血清癌胚抗原(CEA)的水平。随访过程中,结肠镜检查对可疑结肠病变取活检标本送病理科做进一步检查,抽血检测CEA的水平,发现结肠息肉后及时行镜下高频电或圈套器套扎术治疗。对发现可疑病变的复查者进一步做多普勒彩超和CT检查,判断术后有无复发。根据结肠镜和影像检查结果,以及病理检查结果,进一步分析结肠癌患者的性别、年龄、淋巴结转移、术前血清中CEA水平、肿瘤原发部位以及原发肿瘤的病理类型及TNM分期对结肠癌术后预后和复发的影响。结果:所有结肠癌患者术后两年内每6个月进行一次结肠镜检查,共检出吻合口复发癌40例,多原发癌28例,吻合口炎45例,腺瘤性息肉51例,共105枚,均行结肠镜下高频电摘除或圈套器套扎术治疗。随访结果显示:结肠癌根治术后患者的复发情况与原发癌发病时患者的年龄、性别以及原发癌的部位关系并不大,无统计学意义;结肠癌的复发与原发肿瘤的病理类型、分化程度以及TNM分期密切相关,复发率分别为高分化腺癌(14.3%),中分化腺癌(18.3%),低分化腺癌(27.9%),乳头状腺癌(4.7%),以及粘液腺癌(15.3%),Ⅰ期患者(9.1%),Ⅱ期患者(11.7%),Ⅲ期患者(22%),Ⅳ期患者(33.9%);结肠癌患者术前血清中CEA水平以及是否已发生淋巴结转移也是影响根治术后患者复发率和生存率的重要因素,其中原发癌患者血清中CEA水平越高,以及发生淋巴结转移者,术后复发率显著增高,复发率分别为CEA水平≥25 ng/ml的患者21.5%,CEA水平介于5~25ng/ml之间的患者16.8%,CEA水平≤5ng/ml患者5.7%。因此,CEA水平以及淋巴结转移情况可以作为指导临床治疗方案实施的重要参考依据。结论:1.结肠癌患者术后定期随访是结肠癌手术治疗后一个不可缺少的重要环节,是目前根治术后随访最有效的检查手段。2.通过结肠镜能够对结肠息肉直接行电凝切除,有效阻断腺瘤性息肉等癌前病变向癌症转化,对降低结肠癌术后的再复发具有较大的临床价值。3.结肠癌患者术后复发与患者发病时的年龄、性别以及原发肿瘤的位置相关性不大。4.结肠癌的复发与原发肿瘤的病理类型、分化程度以及TNM分期密切相关,其中原发癌病理类型分化程度越低,TNM分期等级越高,结肠癌术后的复发率越高。5.结肠癌患者术前血清中CEA水平以及是否已发生淋巴结转移也是影响根治术后患者复发率和生存率的重要因素,其中原发癌患者血清中CEA水平越高,以及发生淋巴结转移者,术后复发率显著增高,因此,CEA水平以及淋巴结转移情况可以作为指导临床治疗方案实施的重要参考依据。
[Abstract]:Objective: through regular follow-up colonoscopy after radical resection of colon cancer patients, to early detection of postoperative recurrence of colon polyps and colon lesions and lesions of regular colonoscopy and endoscopic follow-up examination, symptomatic treatment to reduce the recurrence rate of colon cancer, the clinical significance of improving survival rate; and the analysis of the will effect of postoperative colon cancer recurrence factors and clinical pathological features of all patients, the prognostic factors of survival of patients with colon cancer. Methods: the Weifang People's Hospital in December 2013 ~2014 year in December from a total of 445 patients with colon cancer resection (including colonoscopy surgery and open surgery patients) and tissue pathology the diagnosis of colon cancer patients with regular colonoscopy follow-up examination, including 130 cases of ascending colon cancer, 70 transverse colon, descending colon cancer in 95 cases, 150 cases of sigmoid colon. Collect all Hospitalized patients during the clinical and pathological data, including gender, age, primary tumor site, tumor histological type and TNM stage, degree of differentiation, lymph node metastasis and preoperative serum carcinoembryonic antigen (CEA) level. During the follow-up, colonoscopy check on suspected colonic lesions from biopsy specimens were sent to the pathology department for further examination, serum CEA level, the timely endoscopic electrosurgical snare or ligation in the treatment of colonic polyps. Further found after Doppler ultrasound and CT examination of suspicious lesions were judged, postoperative recurrence. According to colonoscopy and imaging results, and the results of pathological examination, further analysis of colorectal cancer patients with sex, age, lymph node metastasis, preoperative serum CEA level, pathological type and TNM primary tumor site and primary tumor staging of colorectal cancer recurrence and prognosis 褰卞搷.缁撴灉:鎵，

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