超低位直肠癌根治术中相关保肛因素的Logistic分析

    Relevant factors for anal reservation in radical resection of ultra-low rectal carcinoma:a Logistic analysis

    • 摘要: 目的: 通过建立Logistic回归模型,分析超低位直肠癌根治术中相关保肛因素,探讨超低位直肠癌保肛手术的适应证及手术方式。方法: 选取接受手术的所有距肛缘5 cm以内的超低位直肠癌患者46例,综合患者的性别、年龄、肿瘤距肛缘的距离、肿瘤的大小、分化程度、Dukes分期、术前是否行新辅助治疗、手术方式、是否保留肛门等因素。采用Logistic回归分析的统计学方法进行分析。结果: 在所研究的8个相关因素中,入选模型因素为肿瘤Dukes分期、肿瘤距肛缘距离、术前新辅助放化疗及手术方式,是影响超低位直肠癌保肛手术的主要因素(P=0.048~P=0.011)。结论: 术前应当对超低位直肠癌患者的临床分期进行准确的评估。对于距肛缘4~5 cm、Dukes C期之前的超低位直肠癌患者,可以实施腹腔镜根治性保肛手术。对于距肛缘4 cm以内,即切除后肠道吻合口位于齿状线以下的直肠癌患者,需应用多模式联合治疗,以期根治同时保留肛门。

       

      Abstract: Objective: To study the relevant factors for anus reservation in radical resection of ultra-low-rectal carcinoma through Logistic regression analysis, and to discuss the indications and surgical procedures. Methods: Thirty-six patients with rectal tumors within 5 cm above the anal verge were treated by surgical procedures from Apr. 2007 to Mar. 2008 in our department. The gender,age, location and size of the tumor,degree of differentiation,Dukes stage,operation methods,preoperative neoadjuvant therapy,and whether or not retainning the anus before operation were studied through Logistic regression analysis. Results: The results indicated that the above four factors were the major relevant factors for anus reservation in radical resection of ultra-low-rectal carcinoma(P=0.048-P=0.011). Conclusions: The clinical staging of the patients should be precisely assessed before operation. Patients with the tumors located within 4-5 cm above the anal verge or before Dukes stage C should receive laparoscopic radical operation; and patients with the tumors located below 4 cm above the anal verge should select multi-mode therapies,to achieve radical cure and anal reservation.

       

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