直肠癌延误诊治影响因素及临床处理对策.docVIP

直肠癌延误诊治影响因素及临床处理对策 　　doi：10.3969/j.issn.1007-614x.2014.22.67 　　摘要目的：研究探讨导致直肠癌延误诊治的主要原因以及相应的临床处理措施。方法：收治延误诊治的直肠癌患者19例作为研究对象，对患者的基本临床资料进行回顾，分析患者延误诊治的主要原因及影响因素，并针对不同的原因制定针对性的临床处理措施，观察患者的临床治疗效果，统计治疗有效率并进行5～7年的随访。结果：经再次检查确诊的患者，按病理类型分类，高分化腺癌2例，中分化腺癌10例，低分化腺癌4例，黏液腺癌1例，乳头状腺癌2例；按照直肠癌的Dukes改良分期标准分类，B2期8例，C1期6例，C2期3例，D期2例。根据患者的病情分别实施化疗（2例），直肠癌根治术（12例），姑息手术（5例）。治疗后，对患者进行5～7年的随访，患者的1年生存率78.9%（15/19），3年生存率52.6%（10/19），5年生存率26.3%（5/19）。结论：导致直肠癌的诊断和治疗发生延误的原因涉及到患者自身对相关疾病知识和医疗常识的匮乏、医护工作者的医疗水平、医生在诊断中的疏忽等。医院要从提高直肠癌的临床检测技术和加强医护工作者的责任心培养，强化对相关疾病知识的普及入手，降低直肠癌延误诊断的发生率，提高临床治疗的有效率。 　　关键词直肠癌；延误诊断；影响因素；对策措施 　　Influence factors and clinical treatment countermeasures of delayed diagnosis and treatment of rectal cancer 　　Yuan Xiaoyu 　　The People’s Hospital of Chenxi County，Huaihua City，Hunan 419500 　　AbstractObjective：To study and explore the primary causes and corresponding clinical treatment countermeasures of delayed diagnosis and treatment of rectal cancer.Methods：19 rectal cancer patients with delayed diagnosis and treatment were selected. They were as the research objects.The basic clinical data of patients were reviewed.The main reasons and influencing factors of delayed diagnosis and treatment of patients were analyzed.The specific clinical treatment countermeasures were formulated in view of the different reasons.The clinical curative effects of patients were observed.The treatment effective rate was statistics and the patients were given 5 to 7 years follow-up.Results：The patients were confirmed by checking again，according to the pathological classification；2 cases were high differentiated adenocarcinoma；10 cases were moderately differentiated adenocarcinoma；4 cases were low differentiated adenocarcinoma；1 case was mucinous adenocarcinoma；2 cases were papillary adenocarcinoma.According to the colorectal cancer Dukes improvement staging standards classification，8 cases were B2 stage；6 cases were C1 stage；3 cases were C2 stage；2 cases were D stage.The treatment was respectively im