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

摘要： 背景　吸烟是结直肠癌发病的危险因素之一，且与结直肠癌根治术后复发、转移关系密切。目前，吸烟对结直肠癌患者的危害未得到临床上的足够重视，特别是缺乏针对结直肠癌术后患者戒烟成功率及复吸影响因素的研究。目的　调查并分析就诊时尚未戒烟的结直肠癌患者在术后1年内的戒烟成功率、复吸情况及相关影响因素。方法　选取2014年1月—2017年1月在复旦大学附属闵行医院就诊时尚未戒烟且经肠镜及病理证实的结直肠癌患者。患者常规停止吸烟1~2周后接受结直肠癌根治性手术（开腹手术或腹腔镜结直肠癌根治术），至出院前停止吸烟3~4周，出院时常规宣教。记录患者的一般情况、问卷调查可能影响患者复吸的因素、门诊随访患者复吸情况1年。采用多因素Logistic回归分析探讨结直肠癌患者术后1年复吸的独立影响因素。结果　共收集117例就诊时尚未戒烟的结直肠癌患者，均完成1年随访，70例患者成功戒烟，戒烟成功率为59.8%。复吸47例，复吸率为40.2%。不同性别、文化程度、家庭收入、开始吸烟年龄、烟龄、每日吸烟量、是否晨起5 min内即吸第一支烟、了解与否吸烟有害健康、了解与否吸烟与呼吸系统疾病的关系、术后是否接受常规化疗患者术后1年复吸率比较，差异均无统计学意义（P>0.05）；年龄>55岁患者术后1年复吸率低于≤55岁患者，非独居患者术后1年复吸率低于独居患者，家人朋友反对其吸烟的患者术后1年复吸率低于家人朋友对其吸烟持听之任之态度的患者，了解吸烟与结直肠癌的关系的患者术后1年复吸率低于不了解吸烟与结直肠癌的关系的患者，开腹手术患者术后1年复吸率低于腹腔镜结直肠癌根治术患者，永久性结肠造口患者术后1年复吸率低于非永久性结肠造口患者（P<0.05）。多因素Logistic回归分析结果显示，年龄〔OR=0.276，95%CI（0.104，0.729）〕、独居〔OR=0.190，95%CI（0.044，0.816）〕、家人朋友对其吸烟的态度〔OR=0.279，95%CI（0.108，0.719）〕及是否行永久性结肠造口〔OR=0.162，95%CI（0.032，0.810）〕是结直肠癌患者术后1年复吸的独立影响因素（P<0.05）。结论　结直肠癌术后患者戒烟成功率较低，年龄、是否独居、家人朋友对其吸烟的态度是影响戒烟的主要因素，对于微创手术且未行结肠造口的患者应特别加强控烟教育。

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