摘要：
Objective To study the relationship between degree of mesorectal invasion and circumferential margin (CRM) status in rectal cancer by preoperative CT scan.Methods From February 2010 to February 2014, one hundred and twenty cases of rectal cancer were selected from Enshi Central Hospital, preoperative spiral CT examinations were performed on patients undergoing surgery. The mesorectal invasion and the status of CRM were followed up, and the relationship with prognosis was analyzed by Kaplan-Meier and Pearson method.Results In the 120 patients, there were 51, 32 and 37 cases with mesorectal invasive degree of,,. In each degree group, there was 3.9%, 6.2% and 45.9% with local recurrence; distant metastasis incidence rate 13.7%, 28.1%, 59.5%; the 3-year survival rate was 86.3%, 65.6% and 32.4%, respectively. CRM status was positive in 21 cases, negative in 99 cases. Compared to the negative cases, local recurrence rate, the incidence of distant metastasis and mortality were higher in the positive cases (38.1%vs 13.1%,χ2=6.358,P=0.016; 66.7%vs 24.2%,χ2=11.236,P=0.001; 76.2%vs 27.3%,χ2=16.359,P=0.000). Survival analysis showed that the lower the invasive degree of the mesorectum, the higher the 3-year survival rate of the patients, and the mortality in patients whose CRM was negative was significantly lower than that in the positive patients (P=0.012). There was a negative correlation between the invasiveness of the mesorectum and the postoperative survival time (r=-0.52). The mortality of patients with negative CRM was significantly lower than that of the positive patients (P=0.005). A negative correlation between CRM status and postoperative survival time (r=-0.71) was found. Cox regression showed distant metastasis, the degree of mesorectal invasion, and CRM status were independent prognostic factors of survival.Conclusions Mesorectal invasion and circumferential resection margin status was negatively correlated with the survival time, while mesorectal invasion, circumferential resection margin status, and metastasis are important prognostic factors in patients with rectal cancer. Preoperative CT examination is worthy of attention.%目的 利用术前螺旋CT检查研究直肠癌直肠系膜侵润程度及环周切缘(CRM)状态与患者预后的关系.方法 选取恩施州中心医院2010年2月至2014年2月120例被确诊为直肠癌的患者,对拟行手术治疗的患者行术前螺旋CT检查,术后随访直肠系膜侵润程度与CRM状态,Kaplan-Meier曲线计算生存率,Pearson相关检验与患者预后关系.结果 120例直肠系膜侵润程度Ⅰ度、Ⅱ度、Ⅲ度的患者各51、32、37例,其中局部复发率分别为3.9%、6.2%、45.9%,远处转移发生率分别为13.7%、28.1%、59.5%,3年生存率分别为86.3%、65.6%、32.4%.120例患者CRM状态呈阳性21例,阴性99例,阳性患者的局部复发率、远处转移发生率、死亡率均高于阴性患者(38.1%vs 13.1%,χ2=6.358,P=0.016;66.7%vs 24.2%,χ2=11.236,P=0.001;76.2%vs 27.3%,χ2=16.359,P=0.000).生存曲线及相关性分析显示直肠系膜侵润程度越低,患者3年生存率越高(P=0.012),直肠系膜侵润程度与术后生存时间呈负相关(r=-0.52);CRM状态为阴性患者死亡率明显低于阳性患者(P=0.005),CRM状态与术后生存时间呈负相关(r=-0.71);Cox回归模型显示是否远处转移、直肠系膜侵润程度、CRM状态3个因素是影响患者生存的独立预后影响因素.结论 直肠系膜侵润程度、环周切缘状态与患者生存时间呈负相关,直肠系膜侵润程度、环周切缘状态、是否远处转移是影响直肠癌患者预后重要因素,直肠癌患者术前CT检查值得临床关注.
