直肠癌根治术后盆腔复发的手术治疗（附122例分析）

The sungical management of pelvic recurrence in postoperation for rectal cancer.

本文就该院收治的直肠癌根治术后盆腔复发１２２例的复发形式、发生的原因、预防措施以及外科治疗等进行了分析探讨。指出盆腔复发Ｄｉｘｏｎ术后的吻合口或拉出术后肠管复发及肠旁组织的复发最多见，分别约占１／４或１／３。复发的原因与第一次手术的不彻底有关，如肿瘤远近端肠管切除不足，肠旁组织切除不足，淋巴结清除范围不足。会阴部切除不足是Ｍｉｌｅｓ术后复发的主要原因，认为远端正常肠管应切除３ｃｍ以上，特殊者应切除５ｃｍ以上。上方第三站及们侧方淋巴结清除必须进行。对于复发病例主张再次手术切除。本组再次切除率为６６．７％，其中根治切除率为７１．４％。病灶切除者５年生存率为２２．５％，而根治切除者５年生存率为３６．４％。并对再次手术的术中出血、预防输尿管损伤以及盆底腹膜的修复等提出了自己的观点。

122 pelvic recurrence cases after radical operationfor rectal cancer in our hospital were analysed. The recurrent types, reasons, preventions and surgical mangaement were also discussed in this paper.The anastomic recurrence after Dixon operation orpert-intestine tissues recurrence after pullthrough procedures were more than others, one fourth and onethird, resepectively. The recurrent reasons were inadequete resection which included distal intestine, pert-intestine tissues and lymph nodes in previous operation.The maln reason after miles operation was inadequateresection of perineal tissues. We suggested that theupper third and the side lymph nodes should be removed. The distal normal intestine should be excisedmore than 3cm,in special,more than 5cm. We assertedthe surgical resection in mangement of recurrent cases. The resected rate was 66. 7 % and its radically resected rate was 71. 4%. The five year survival rateswas 22. 5 %, 36. 4 %, resepectively. The prevention ofbleeding, urinary tubes injury and peritoneaum repaired in reoperation were also pointed out in this paper.