대장 및 직장암에 대한 임상적 고찰 및 원격성적

Abstract

[한글]1967년부터 1976년까지 만 10년간 전주예수병원에서 병상기록을 이용할 수 있었던 대장 및 직장 암환자 261례에 대하여 성별, 연령, 임상증세, 병력기간, 발생부위, 병리조직소견, 암세포의 분화도, Dukes' Classification, 병합질환 및 수술방법등을 분석하였으며 ,

수술한 164례에 대한 병기별 원격성적과 수술치료에 대한 원격성적을 비교 분석하여 다음과 같은 결과를 얻었다.

1. 호발연령은 40대 및 50대로 두 연령군이 전체의 49%를 차지하였다.

2. 남녀비율은 1.4:1로서 남자에 호발하였다.

3. 대장암의 경우 증상은 체중감소가 59.1%, 직장암의 경우 혈변이 86.3%로 가장 많았다.

4. 병력기간은 6개월이내가 55.4%, 1년이내가 82.3%로서 평균 병력기간은 8.3개월이었다.

5. 호발부위는 직장항문부가 55.9%, S-자상결장이 11.5%로서 두 부위가 전체의 67.4%를 차지하였다.

6. 병리조직소견은 선암이 95.2%로 가장 많았다.

7. 암의 진행정도에 대한 분포는 Dukes'A가 1.2%, Dukes'B 31.8%, Dukes'C 및 D가 각각 33.5%를 나타내었다.

8. 근치절제를 한 경우는 164례 중에 118례(72%)이었고, 이중 가장 많은 것은 복회음절제술로서 29%이었다.

9. 수술후 합병증은 모두 25.6%이었고 가장 많은 것이 장폐쇄증으로 9.8%이었다.

10. 수술후사망자는 2례(1.2%)이었고, 폐염 및 횡격막하농양으로 사망하였다.

11. 수술받은 164례에 대한 전체적인 5년 누적생존율은 53.2%이었고, 암의 침습 정도에 따른 5년생존율은 Dukes'B 79.6%, Dukes'C 48.3%이었으며, Dukes'D의 5년생존자는 없었다.

12. 근치절제술 단독으로 실시한 118례에 대한 5년간 누적생존율은 63.8%이었다.

[영문]The colo-rectal cancer is low incidence in Korea compared to Western country, but recently, has shown a slightly increased in its incidence in Korea.

The treatment of colo-rectal cancer is various, but surgical management is very important with early detection of cancer and by far the most important factor in survival is the presence or absence of the involved nodes.

The clinical observation was performed on 261 cases of the coco-rectal cancer from 1967 to 1976 at Cancer Registry of the Presbyterian Medical Center, Jeonju, Korea.

The results are as follows;

1) The peak incidence occurred in 5th and 6th decades of life, accounting for 49% 0of all patients.

2) The ratio between male arid female was 1.4 to 1.

3) The most common symptoms and signs of colon cancer were weight loss (59.1%) and obstruction (55.7%). In the rectal cancer, bloody stool (86.3%) is the most frequent symptom followed by change of bowel habit (71.9%).

4) Most patient came to the hospital within 1 year (82.3%) after onset of the symptoms and signs. The mean duration of the symtpoms was 8.3 months.

5) The most common location of the lesion was anorectal area (55.9%), sigmoid colon (11.5%) the next.

6) The most common type of the cancer was adenocarcinoma (95.2%) in all patients.

7) As to the obtained on the histologic grade of the lesion, 57.4% were in well differentiation, 21.9% in moderate differentiation and 20.7% in poor differentiation.

8) As to the extent of the lesion, 1.2% were in Dukes' classification A, 31.8% in Dukes' B, 33.5% in Dukes' C and 33.5% in Dukes' D.

9) The hemorrhoid was the most associated disease (8.4%) in all patients.

10) The rate of resection with the intent of cure was 72% in 164 cases and Miles' operation was most commonly performed.

11) The rate of postoperative complication was 25.6% in all patients and the intestinal obstruction was most commonly occurred (9.8%).

12) The postoperative mortality rate was 1.2% and the causes of death were pneumonia and subphrenic abscess.

13) The cummulative 5-year curvival rate without regarding the stage were as follows; 5-year survival in 53.2%, 4-year in 54.9%, 3-year in 63.5%, 2-year in 73.3% and 1-year 83.7%.

14) As to the cummulative survival rate according to the lesion, the 5-year survival rate was 79.6% for patient with Dukes' B and 48.3% for Dukes' C.

For the patient with Dukes' D lesion, the 4-year or 5-year survival was absent. Because only two cases were noted that 5-year survival for the patient with Dukes' A was insignificant.

15) As to the survival rate according to the treatment, the cummulative 5-year survival rate was 63.8% with the curative surgery and 17.1% in cummulative 3-year survival rate after palliative surgery.