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目的：探讨影响直肠癌根治术后远处转移的临床特点。方法：回顾性分析中国医学科学院肿瘤医院１９８０年 １月～１９９３年 １２月直肠癌根治性手术后患者８０１例，对影响转移因素做了统计学处理。结果：术后发生转移患者１５８例，转移部位依次为：肺转移６９例，肝转移及腹股沟淋巴结转移各３４例，术后３年内转移发生率占７５．０％（１１９／１５８）。影响转移因素包括：肿瘤分化程度（Ｐ＜０．０１），Ｄｕｋｅｓ：分期（Ｐ＜０．００１）；低位直肠癌转移发生率高（Ｐ＜０．０５），粘液腺癌及印戒细胞癌容易发生转移（Ｐ＜０．０５）。腹股沟淋巴结转移主要发生于肿瘤距肛门≤７ｃｍ患者，占９１．２％（３１／３４）。二次手术切除转移灶患者５年生存率为 ２８．６％（４／１４），非手术治疗患者无 １例生存５年。结论：直肠癌根治手术后肺转移最多见，其次是肝及腹股沟淋巴结转移，对适合手术切除的转移患者再次手术切除转移病变是首选的治疗方法。
Objective: To explore the clinical features affecting distant metastasis after radical resection of rectal cancer. METHODS: A retrospective analysis of 801 patients with radical rectal cancer from January 1980 to December 1993 in the Cancer Hospital of the Chinese Academy of Medical Sciences was performed. Statistical analysis was performed on the factors affecting metastasis. RESULTS: Among 158 patients with postoperative metastases, the metastatic sites were: lung metastasis in 69 cases, liver metastasis, and inguinal lymph node metastasis in 34 cases. The rate of metastasis within 3 years after operation was 75.0% (119/158). Factors affecting metastasis included: tumor differentiation (P<0.01), Dukes: staging (P<0.001); high incidence of low rectal cancer metastasis (P<0.05), mucinous adenocarcinoma and signet-ring cell carcinoma Metastasis easily (P<0.05). Inguinal lymph node metastasis occurred mainly in patients with tumors less than or equal to 7 cm from the anus, accounting for 91.2% (31/34). The 5-year survival rate of patients undergoing secondary resection of metastases was 28.6% (4/14). None of the non-surgical patients survived for 5 years. Conclusion: The lung metastasis after radical surgery for rectal cancer is the most common, followed by metastasis of the liver and inguinal lymph nodes. It is the first choice for surgical resection of metastatic lesions in metastatic patients undergoing radical resection.