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目的探讨青年结直肠癌病人的临床病理特点及外科治疗方法。方法对哈尔滨医科大学附属第三临床医学院1976-2007年收治的216例30岁以下结直肠癌病人的发生率、部位、临床症状、术前合并症、术式、病理、术后并发症等因素进行回顾分析。结果男性137例,女性79例,占同期手术病人的5.2%。病变部位以直肠(136例)和乙状结肠(41例)多见,占总数81.9%(177/216)。直肠癌距肛缘平均距离4.5cm。右半结肠13例,占总数6.0%。以大便习惯改变和间歇性黏液血便为主要症状。术前合并肠梗阻、肠穿孔、严重贫血等33例(15.3%)。159例(73.6%)行根治术,57例(26.4%)行姑息术。根治术、姑息术5年存活率分别为46.4%和0。急诊手术13例(6.0%)。术后15例(6.9%)出现肠梗阻、出血、感染等并发症。结论青年结直肠癌病人,发病部位以直肠多见。病理以低分化腺癌、印戒细胞癌较多,易发生转移与种植,预后差。加强直肠肛诊检查,以期早期诊断和早期治疗。术式以保留神经的扩大根治术为首选,可达到较高的根治率和生活质量。
Objective To investigate the clinicopathological features and surgical treatment of young patients with colorectal cancer. Methods The incidence, location, clinical symptoms, preoperative complications, surgical procedures, pathology, postoperative complications, etc. of 216 patients with colorectal cancer under 30 years of age admitted to the Third Clinical Medical College Affiliated to Harbin Medical University from 1976 to 2007 Factors to review the analysis. Results There were 137 males and 79 females, accounting for 5.2% of the surgical patients in the same period. Lesions were more common in the rectum (136 cases) and sigmoid colon (41 cases), accounting for 81.9% (177/216) of the total. Rectal cancer from the verge of the average distance 4.5cm. The right colon in 13 cases, accounting for 6.0% of the total. Changes in stool habits and intermittent mucus bloody stool as the main symptoms. Preoperative combination of intestinal obstruction, intestinal perforation, severe anemia in 33 cases (15.3%). Fifty-nine patients (73.6%) underwent radical surgery and 57 patients (26.4%) underwent palliative surgery. The 5-year survival rates of radical surgery and palliative surgery were 46.4% and 0 respectively. Emergency surgery in 13 cases (6.0%). Postoperative 15 cases (6.9%) showed intestinal obstruction, bleeding, infection and other complications. Conclusion young patients with colorectal cancer, the incidence of more common parts of the rectum. Pathology with poorly differentiated adenocarcinoma, signet ring cell carcinoma more prone to metastasis and planting, the prognosis is poor. Strengthen the rectal examination, with a view to early diagnosis and early treatment. Surgery to retain the nerve expansion of the radical surgery as the preferred, to achieve a higher cure rate and quality of life.