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1、結(jié)直腸癌肝轉(zhuǎn)移相關(guān)臨床病理危險(xiǎn)因素分析作者：黃輝1,季惠1,黃建昌1,施飛1,全志偉2,楊明2,杜鵬2,翁子毅2作者單位：(1?崇明縣堡鎮(zhèn)人民醫(yī)院外科，上海202157;2.±海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院普外科，上海200092)【摘要】目的分析與結(jié)直腸癌肝轉(zhuǎn)移相關(guān)的臨床病理學(xué)危險(xiǎn)因素。方法收集2002年1月至2004年12月經(jīng)手術(shù)切除原發(fā)灶、病理證實(shí)和完成隨訪的390例結(jié)直腸癌患者的臨床病理資料。采用成組病例■對照研究法，將患者分為肝轉(zhuǎn)移和無肝轉(zhuǎn)移兩組，選擇腫瘤部位、大體類型、腫瘤長徑、浸潤周徑、浸潤
2、深度、靜脈癌栓、淋巴結(jié)轉(zhuǎn)移位置、淋巴結(jié)轉(zhuǎn)移數(shù)目和組織學(xué)類型等因素，用SAS6.12進(jìn)行結(jié)直腸癌肝轉(zhuǎn)移單因素分析和多因素Logistic回歸分析，并對有意義的因素進(jìn)行交互作用分析。結(jié)果單因素分析顯示：結(jié)直腸癌浸潤腸管壁的周徑(P=0.022)、浸潤深度(P=0?001)、靜脈癌栓(P=0.001)、淋巴結(jié)轉(zhuǎn)移位置(P=0.001)和肝轉(zhuǎn)移相關(guān);多因素分析顯示：靜脈癌栓(P=0.005)和淋巴結(jié)轉(zhuǎn)移位置(P=0.001)和肝轉(zhuǎn)移和關(guān)，靜脈癌栓和淋巴結(jié)轉(zhuǎn)移位置無交互作用。結(jié)論腫瘤浸潤周徑、浸潤深度、靜脈癌栓及
3、淋巴結(jié)轉(zhuǎn)移與發(fā)牛?結(jié)直腸癌肝轉(zhuǎn)移密切相關(guān)，術(shù)后病理檢查發(fā)現(xiàn)伴隨有靜脈癌栓及淋巴結(jié)轉(zhuǎn)移的結(jié)直腸癌患者發(fā)生肝轉(zhuǎn)移的危險(xiǎn)性較大，而癌腫部位、大體類型、腫瘤長徑、淋巴結(jié)轉(zhuǎn)移數(shù)冃和組織學(xué)類型與肝轉(zhuǎn)移的發(fā)生無關(guān)。【關(guān)鍵詞】結(jié)直腸癌;肝轉(zhuǎn)移;臨床病理特征;因素分析AbstractObjectiveToexploretheclinicopathologicalriskfactorsofcolorectalcarcinomarelatedtolivermetastases?MethodsTheclinicopatholo
4、gicrecordsandthefollow-updataof390patientswithcolorectalcarcinomaundergoingoperationbetweenJanuary2002andDectember2004werecollectedtobeanalyzedretrospectively.Allthepatientsweregroupedintoonewithlivermetastasisandonewithoutlivermetastasis.Thecollectedcli
5、nicopathologicalfeaturesincludedlocationandsizeoftumor,pathologicalgrade,histologicaltype,infiltratingdepthandcircumference,venouscancerousembolusandlymphnodemetastasis.Univariateanalysisandmultinomiallogisticregression(SAS6.12forwindows)andthencorrelati
6、onanalysiswerecarriedouttoevaluatethefactorsconcerned?ResultsUnivariateanalysisrevealedthatinfiltratingcircumference(P=0.022),infiltratingdepthandvenouscancerousembolus(P=0.001),lymphnodemetastasis(P=0.001)wererelatedtohepaticmetastasis.Multivariateanaly
7、sisrevealedthatonlyvenouscancerousembolusandlymphnodemetastasiswererelatedtohepaticmetastasis.Theanalysisoflogisticregressionillustratedthatvenouscancerousembolusdidnotinteractwithlymphnodemetastasis.ConclusionOurresultsshowedthatinfiltratingdepthandcirc
8、umference,venouscancerousembolusandlymphnodemetastasisaremainfactorsrelatedtolivermetastasisfromcolonrectalcarcinoma.Livermetastasisiseasytobefoundinpatientswithcolorectalcarcinomainwhichthefeaturesarevenouscancerousembolu
