关键词: 结直肠肿瘤, 吸烟, 戒烟, 影响因素分析, 年龄因素, 独立生活, 结肠镜检查

Abstract: Background　Smoking is one of the risk factors for colorectal cancer，and is closely associated with the recurrence and metastasis of colorectal cancer after operation.The harm of smoking to patients with colorectal cancer has not achieved sufficient clinical attention，and the research on smoking cessation rate and factors influencing relapse in such patients is rare.Objective　To investigate smoking cessation rate and factors influencing relapse in colorectal cancer patients who had smoking habit at admission within one year after operation.Methods　From January 2014 to January 2017，117 patients who had not quit smoking when diagnosed with colorectal cancer by colonoscopy and pathology at Minhang Hospital，Fudan University were enrolled.They received radical colorectal cancer surgery （laparotomy or laparoscopic minimally invasive surgery） 1 to 2 weeks after routine cessation of smoking.The patients stopped smoking for 3-4 weeks and received regular health education before discharge.The general condition of the patients were recorded，the information of factors that may influence the relapse were obtained through a questionnaire survey，and the situation of relapse was observed through one-year out-patient follow-up.The smoking cessation rate and independent factors influencing relapse were analyzed with multivariate Logistic regression.Results　A total of 117 cases were included，and all of them completed one-year follow-up.Smoking cessation rate was 59.8%（70/117），and smoking relapse rate was 40.2%（47/117）．Sex，education level，monthly household income，age of starting to smoke，smoking age，daily cigarette consumption，having the first cigarette within 5 minutes of waking up in the morning，understanding level of the dangers of smoking，understanding level of the relationship between smoking and respiratory diseases，and receiving regular postoperative chemotherapy were not associated with postoperative one-year smoking relapse rate （P>0.05）．Age >55 years old，not living alone，family members and friends opposing smoking，understanding the relationship between smoking and colorectal cancer，undergoing laparotomy，and having a permanent colostomy were associated with a lower smoking relapse rate （P<0.05）．Multivariate Logistic regression analysis showed that age 〔OR=0.276，95%CI（0.104，0.729）〕，living alone 〔OR=0.190，95%CI（0.044，0.816）〕，attitudes of family and friends towards smoking 〔OR=0.279，95%CI（0.108，0.719）〕and whether having a permanent colostomy 〔OR=0.162，95%CI（0.032，0.810）〕 were independent influencing factors for postoperative one-year smoking relapse in colorectal cancer patients （P<0.05）．Conclusion　Postoperative one-year smoking cessation rate in patients with colorectal cancer is less than desirable.Age，living alone or not，family members and friends' attitudes toward smoking are the main factors that affect patients smoking cessation.Tobacco control should be strengthened especially for those undergoing minimally invasive surgery without colostomy.

Key words: Colorectal neoplasms, Smoking, Smoking nessation, Root cause analysis, Age factors, Independent living, Colonoscopy