直肠癌术后局部复发再手术41例临床分析

Clinical analysis of 41 reoperational patients with recurrent rectal cancer

目的探讨直肠癌术后局部复发的原因及再手术的临床效果。方法回顾分析1997-2002年41例直肠癌术后局部复发再手术病人的临床资料。结果吻合口处复发17例，盆腔内复发15例，会阴部复发（含造瘘口）9例。本组病例均经再次手术治疗．根治性切除24例，姑息性切除13例，行高位结肠造瘘4例。根治性切除和非根治性切除病人的中位生存时间分别为36个月和11个月。结论首次手术应切除足够的肠管，彻底清除淋巴结及所在的肠系膜，术中严格无瘤操作，围手术期制定合理的综合治疗措施是预防复发的关键因素。术后定期随访复查，对于局部复发早发现早再次手术可以延长生存期，提高生活质量。

Objective To explore the factors related to recurrence of rectal cancer and the clinical effect of reoperation. Methods 41 reoperational cases suffering from recurrence of rectal cancer between 1997 and 2002 were analyzed retrospectively, Results The sites of recurrence were： anastomotic stoma in 17 cases, pelvic cavity in 15 cases, perineum in 9 cases. All tb.e 41 patients were received reoperation, in whom 24 were treated with radical resection and 13 with palliative resection. The median survival time for radical and nonradical resection was 36 months and 11 months respectively, Conclusion Extensive resection of the intestine and underlying mesentery as well as thorough elimination of lymph nodes are the major measures to prevent recurrence, Regular follow-up is essential to early detection of recurrence, Active surgical intervention is often mandatory for recurrent rectal cancer.