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目的探讨影响结直肠癌腹膜转移手术疗效的预后因素。方法回顾性分析中山大学附属第六医院2011年1月至2015年1月行手术治疗的75例结直肠癌腹膜转移病人的临床及随访资料,分析不同手术方式病人的预后。结果总体生存时间为18.6(11.7~25.6)个月。完全性切除、不完全性切除及减状手术(单纯造口或短路手术)病人的中位生存时间分别为38.2、10.4和10.4个月。与减状手术相比,完全性切除病人有明显生存获益(P<0.001),而不完全性切除病人则无生存获益(P=0.524)。多因素分析示,腹膜癌指数(PCI)<20、完全性切除及单纯性腹膜转移是预后良好的独立因素。不完全性切除与减状手术病人Clavien-Dindo分级≥Ⅱ级并发症发生率分别为22.2%和0,术后30 d病死率分别为7.4%和0。结论接受完全性切除手术的结直肠癌腹膜转移病人的预后较好;与减状手术相比,不完全性切除并不能改善病人预后。
Objective To investigate the prognostic factors affecting the efficacy of peritoneal metastasis of colorectal cancer. Methods The clinical data and follow-up data of 75 patients with peritoneal metastasis of colorectal cancer who underwent surgery from January 2011 to January 2015 in the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The prognosis of patients with different surgical modalities was analyzed. Results The overall survival time was 18.6 (11.7 ~ 25.6) months. The median survival time was 38.2, 10.4, and 10.4 months for patients who underwent complete resection, incomplete resection, and orthotic surgery (simple ostomy or short-circuit surgery). Patients who underwent complete resection had a significant survival benefit compared with those who underwent surgery (P <0.001), whereas patients who did not undergo complete resection had no survival benefit (P = 0.524). Multivariate analysis showed that peritoneal cancer index (PCI) <20, complete resection and simple peritoneal metastasis were independent prognostic factors. Clavien-Dindo grade ≥ Ⅱ complication rates were 22.2% and 0 respectively for patients with incomplete resection and subtraction surgery, and mortality rates were 7.4% and 0 after 30 days respectively. Conclusion The prognosis of patients with peritoneal metastasis of colorectal cancer undergoing complete resection is better. Incomplete resection does not improve the prognosis of patients with peritoneal metastasis of colorectal cancer.