大肠癌术后复发和转移的临床研究─—附82例分析

A CLINICAL STUDY OF RECURRENT COLORECTAL CANCERFOLLOWING CURATIVE RESECTION-ANALYSIS OF 82 CASES

本文报告大肠癌术后复发和／或转移８２例。男４６例，女３６例，年龄１９～７５岁，平均４６．３岁。复发时间３月～１７年，平均２５．６月，２年以内６０例，占７３．２％。直肠癌以局部夏发为主（５２．６％），结肠癌以远处转移为主（６３．６％）。直肠癌Ｍｉｌｅ’ｓ术后复发以盆腔、会阴为主（７１．４％），行吻合术者则以吻合口复发为主（６９．２％）。临床表现以急、慢性肠梗阻、粘液皿便、能前区疼痛、腹部包块、会阴结节或窦道为主。ＣＥＡ阳性率３７．９％。再次手术６８例，根治性切除１４例（１７．１％），姑息性切除１２例（１４．６％），病灶总切除率３１．７％，根治性切除和姑息性切除３、５年生存率分别为７２．７％、６２．５％和２０．ｏ％、１１．１％（Ｐ＜０．００１）；造瘘、短路等手术和非手术治疗者，无２年生存者。其中位生存期为８．２月。本组手术死亡１例（１．４７％），并发症１６例（２３．５％），早期发现和诊断是提高大肠癌再手术疗效的关键，术后定期随访是早则发现和诊断复发的行效途径。对复发或转移病人的再手术应持积极态度。

group of 82 cases of recurrent colorectal cancer following curative resec-tion was reported in this paper. There were 46 men and 36 women with an agerange from 19 to 75 years and median age of 46. 3 years. The recurrent timeranged from 3 months to 17 years and median time of 25. 6 months. Recurrenceoccurred in 60 (73. 2%) within 2 years. The recurrence was mainly local(52. 6%) in rectal cancer and mainiy distant (63. 6%) in colonic cancer. Localrecurrence was mainly located in the pelvic cavity and perineum (71. 4% ) follow-ing Mile, s procedure and at the anastomosis (69. 2%) following Dixon proce-dure. The clinical symptoms were partial or complete obstraction of bowel,bloody stools and mucous in stools. pain in sacrococcyx, abdominal mass andperineal node or sinus. The positive rate of CEA was 37. 9%. Of the 82 pa-tients , 68 underwent surgical treatment , 14 of 68 patients underwent potientiallycurative resection ( 17. 1% ) , 12 of 68 patients underwent palliative resection.The resective rate was 31. 7%. The 3-year and 5-year survival rates were 72.1% and 62. 5% respectively in curative resection group and in palliative resectiongroup , it was 20. 0% and 11. 1% respectively. For the other procedures such ascolostomy, bypass , and non-surgical treatment , there were no 2-year survival ,and most of these patients (82%) died within 3 to 12 months , with median sur-vival time of 8. 2 months. The operative motahty was 1. 47% and operalive com-plicaton rate was 23. 5% in surgical treatment group. Early detection and diag-nosis is the key to increase the curative rate of recurrent colorectal cancer. Inten-sive followup is the way to detect recurrent colorectal cancer. Operation forrecurrent colorectal cancer must be done as early as possible.