直肠癌Miles术后会阴部复发的诊治分析

Diagnosis and Treatment of Perineal Recurrence in Patients with Rectal Cancer after Miles Operation

目的探讨直肠癌术后会阴部复发的诊断和治疗。方法回顾分析1991年～2003年收治的15例直肠癌术后会阴部复发病人。结果13例有会阴部肿块,2例有会阴阴道瘘。术前CEA、CA19-9检测,CT检查,肿块穿刺细胞检查以及术中病灶切除快速病检对该病有诊断价值。10例会阴部复发者行根治性手术切除,姑息性复发病灶切除3例,未能切除2例。根治手术组3例发生并发症。根治性切除组10例,7例无瘤生存,其中1年2例,2年3例,5年以上2例。结论对会阴部诊断要结合临床及检查结果综合分析,治疗要慎重,早期确诊、尽早手术是提高治愈率的关键。

Objective To explore the diagnosis and treatment of perineal recurrence in patients with rectal cancer after Miles operation. Methods The 15 cases of perineal recurrent patients with rectal cancer after Miles operation were analysed retrospectively from 1991 to 2003. Results The perineal mass was found in 13 cases. Another two cases were perineavaginal fistula. The preoperative CT scan ,CEA, CA19-9, tumour pucture biopsy and the resected mass biopsy in operation were valuable to the diagnosis. The curative operation was performed on 10 cases of perineal recurrence , palliative resection in 3 cases, and unresectable in 2 cases. The complication occurred in 3 cases after curative operation. In 10 cases of curative operation, 7 patients were still alive with no tumor in 1 year, 3 patients in 2 years and 3 patients were over 5 years. Conclusion Analysing clinical and laboratory examination is helpful to the diagnosis of perineal recurrence. For treatment choice, we must adopt a prudent policy. The key point forimproving curative rate is early diagnosis and operation.