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目的总结直肠癌治疗的总体效果,制定切实可行的质量控制标准。方法建立数据库,回顾性总结我院2000年1月~2003年9月收治的直肠癌手术病人326例的临床资料,包括病人一般资料、症状和体征学资料、实验室检查及影像学资料、手术情况、肿瘤临床病理学分期、术后并发症、生活质量、随访资料等8个部分。对所有数据进行统计学处理,观察不同手术者、不同手术方法可能对病人临床结局造成的影响。结果326例病人行全直肠系膜切除术140例(42.9%),经腹会阴直肠癌根治术113例(34.7%),低位前切除术182例(55.8%),HARTMANN手术18例(5.5%),全盆切除术1例(0.3%),局部切除4例(1.2%),结肠造口术8例(2.5%)。围手术期死亡2例,病死率0.61%;手术后共有54例病人发生各种并发症,总的并发症发生率为16.7%;不同的手术者术后病人并发症的发生率从8.3%~25.0%不等,胃肠专业医师和非胃肠专业医师手术后病人并发症发生率、手术后主要生命质量指标比较,差异具有统计学意义(χ2=3.89~12.90,P<0.05)。术后平均随访时间为23个月,肿瘤总的复发率为7.8%。术后1、2、3年的生存率分别为96.88%、87.70%、72.97%。结论多指标直肠癌数据库的建立对直肠癌个体化手术治疗质量控制具有可行性;要达到直肠癌合理化手术、提高手术效果、减少手术并发症、改善手术后病人生命质量,应提倡专业医师负责制和专病医师负责制。
Objective To summarize the overall effect of treatment of rectal cancer and develop practical quality control standards. Methods To establish a database to retrospectively summarize the clinical data of 326 patients with rectal cancer treated in our hospital from January 2000 to September 2003, including general information, symptoms and signs, laboratory tests and imaging data, surgery Cases, clinical and pathological staging of tumor, postoperative complications, quality of life, follow-up data and other eight parts. All data were statistically processed to observe different surgical patients, different surgical methods may affect the patient’s clinical outcome. Results Thirty-two cases (42.9%) underwent total mesorectal excision, 113 cases (34.7%) underwent transabdominal perineal radical resection, 182 cases (55.8%) underwent anterior resection and 18 cases (5.5%) underwent HARTMANN operation , 1 case (0.3%) with total basin excision, 4 cases (1.2%) with partial resection and 8 cases (2.5%) with colostomy. Perioperative death in 2 cases, the mortality rate of 0.61%; after surgery a total of 54 patients with various complications, the total complication rate was 16.7%; different surgical patients postoperative complication rate from 8.3% 25.0%. The complication rate of postoperative gastrointestinal and non-gastrointestinal physicians was significantly higher than that of postoperative patients (χ2 = 3.89-12.90, P <0.05). The mean follow-up time was 23 months, with a total tumor recurrence rate of 7.8%. The survival rates at 1, 2 and 3 years after operation were 96.88%, 87.70% and 72.97% respectively. Conclusion The establishment of multi-index rectal cancer database is feasible for the quality control of individualized surgical treatment of rectal cancer. To achieve the rationalization of rectal cancer surgery, improve the surgical effect, reduce the surgical complications and improve the quality of life of patients after surgery, the professional physician responsibility system should be advocated And specialist doctor responsibility system.