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目的研究影响大肠癌淋巴结转移的各种临床及病理因素之间的关系,为临床诊断及治疗提供参考.方法收集我院1975/1999年间手术治疗的大肠癌1374例,对全部病例及随访资料进行分析,建立 ACCESS 数据库,进行检索,采用排列组合的方法,逐个分析年龄、浸润深度、侵犯肠管周径、病理类型、分化程度、生长方式、肿瘤部位之间的相关性.统计方法采用行×列表资料的 X~2检验.结果小于30岁年龄组大肠癌浸润肠管周径较其他年龄组高,其粘液腺癌、印戒细胞癌所占比例分别为22.7%(17/75),14.7%(11/75),较其他年龄组均多(P=0.000 X~2=72.22);与肿瘤浸润肠管周径有关的因素有肿瘤浸润肠壁深度(P=0.000 X~2=353.58),肿瘤生长方式(P=0.000X~2=155.35),肿瘤分化程度(P=0.035 X~2=13.53)肿瘤病理类型(P=0.000 X~2=31.64),肿瘤部位(P=0.000X~2=44.73);粘液腺癌及印戒细胞癌浸润至浆膜层的比例为81.6%(120/147)和86.36%(19/22)显著高于腺癌组67.7%(574/848);分化程度低的肿瘤及浸润性生长的肿瘤其浸润肠壁的深度增高;直肠癌及乙状结肠癌浸润到肠壁外的比例分别为要较其他组低(P=0.000 X~2=36.96).升结肠,横结肠,降结肠癌中粘液腺癌所占比例均较乙状结肠及直肠高(P=0.000X~2=83.55),其中横结肠癌中粘液腺癌所占比例高达38.5%(40/104).高分化,中分化,低分化癌中浸润性生长者分别为55.8%(191/342),62.5%(226/361),68.9%(59/86)组间比较有显著性差别(P=0.002 X~2=21.48).结论影响大肠癌淋巴结转移的各因素之间是相互联系、相互影响的.不可能以单一的某种因素作为判断其有无淋巴结转移的指标,临床上需综合分析各种因素所起的作用才能对病情进行合理正确的评估,制定合理的治疗方案.
Objective To study the relationship between various clinical and pathological factors affecting lymph node metastasis of colorectal cancer and to provide reference for clinical diagnosis and treatment.Methods A total of 1374 cases of colorectal cancer surgically treated in our hospital from 1975 to 1999 were collected and all the cases and follow- Analysis, establish ACCESS database, search, the use of permutation and combination of methods, one by one analysis of age, infiltration depth, invasion of intestinal circumference, pathological types, differentiation, growth patterns, tumor correlation between the statistical methods using row × list Results The X-2 test of colorectal cancer in the group of less than 30 years old was higher than that in other age groups, and the percentage of mucinous adenocarcinoma and signet-ring cell carcinoma was 22.7% (17/75) and 14.7% (P = 0.000 X ~ 2 = 72.22). The factors related to tumor infiltrating intestine circumference were tumor infiltration depth (P = 0.000 X ~ 2 = 353.58), tumor growth (P = 0.000 X ~ 2 = 155.35), tumor differentiation (P = 0.035 X ~ 2 = 13.53) ). The proportion of mucinous adenocarcinoma and signet-ring cell carcinoma infiltrating into serosa was 81.6% (120/147) and 86.36% (19 / 22) was significantly higher than adenocarcinoma group 67.7% (574/848); poorly differentiated tumors and invasive growth of the tumor infiltrating the depth of the intestinal wall increased; rectal cancer and sigmoid colon infiltration outside the wall to the ratio of (P = 0.000 X ~ 2 = 36.96). The proportion of mucinous adenocarcinomas in ascending colon, transverse colon and descending colon cancers were higher than those in sigmoid colon and rectum (P = 0.000X ~ 2 = 83.55) Mucous adenocarcinoma accounted for as high as 38.5% (40/104). The infiltrative growth rate in highly differentiated, moderately differentiated and poorly differentiated cancer were 55.8% (191/342), 62.5% (226/361), 68.9% (P = 0.002 X ~ 2 = 21.48) .Conclusion The various factors that affect the lymph node metastasis of colorectal cancer are interrelated and influence each other.It is impossible to take a single factor As an indicator to determine whether there is lymph node metastasis, the clinical need to comprehensively analyze the role played by various factors in order to make a reasonable and correct assessment of the disease, to develop a reasonable treatment.