直肠癌术后复发及转移的外科治疗

Surgical Management of Recurrence and Metastasis of Rectal Cancer

１９８０～１９９０年，作者行直肠癌治愈性切除术共１６０例，随访４年～１４年。术后复发及转移４４例（２７．５％）。再次手术１７例（３８．６％）。其中治愈性切除６例（１３．６％），姑息性切除５例（１１．４％），单纯结肠造瘘６例（１３．６％）。全部再手术患者有６例生存超过５年，５年生存率３５．３％，未经手术治疗者无１例存活超过５年，两者比较差异非常显著（ｐ＜０．００５）。即使行姑息手术者，２年生存率（６３．６％）也明显高于非手术组（３７％，Ｐ＞０．０５）。可见对直肠癌术后复发或转移再次手术不仅可以改善症状，提高生存质量，而且部分患者可获长期生存。

From 1980 to 1990,160 cases of rectal carcinoma were treated by curative excision.The follow-upperiod was 4 to 14 years. 44( 27.5%)patients developed recurrence and metastasis.17 ( 38.6%)patients with localrecurrence or distal metastasis received second surgical treatment. Among them 6( 13.6%)patients were treated bycurative resection,5(11.4%)patients by palliative resection. and 6(13.6%)patients by single colostomy. Amongthose patients undergone second operation, 6 cases had a survival time more than 5 years and 5 year survival rate was35.7%,The 5 year survival of patients without resection was 0%, there was significant difference between twogroups(P<0.05). The 2 year survival rate of all patients with palliative resection(63.6%)was higher than allpatients without resection(37%,P>0.05).It can be seen that a second operation for recurrent rectal cancer notonly provids short term relief of the symptoms , but also offers hope for cure or long-term survival to a part ofpatients。