直肠癌术后局部复发的原因及预防、治疗对策

The cause,prevention and treatment strategy of local recurrence after operation for rectal carcinoma

目的 探讨直肠癌术后局部复发的原因、术中预防及治疗方法。方法 回顾性分析再手术治疗的局部复发性直肠癌52例。结果 全组患者会阴及盆腔复发14例，吻合口复发31例，阴道壁复发4例，前列腺复发2例，腹壁切口种植1例。36例再行根治性手术，13例行姑息性切除手术，3例行肠造口术。根治术组和姑息术组中位生存期分别为33．5（12～80）个月和12（3～23）个月。结论 对于局部复发性直肠癌仍应积极手术，术中彻底切除病灶和正规的淋巴清扫，可以延长生存期，提高生存质量。

Objective To discuss the causes, the methods of intraoperative prevention and treatment of local recurrence in patients after operation for rectal carcinoma. Methods Fifty-two re- operated patients with local recurrence of rectal carcinoma were analyzed retrospectively. Results In these 52 patients , there were 14 patients with perianus and pelvic cavity recurrence, 31 patients with stoma recurrence, 4patients with vaginal wall recurrence , 2 patients with prostate gland recurrence and 1 patient with implantation in the incision of abdominal wall . Among them, 36 patients underwent radical operation, 13 patients had palliative resection and 3 patients were treated by enterostomy. The median survival time for the groups who underwent radical operation and palliative resection was 33. 5 （ 12 - 80 ） months and 12 （ 3 - 23 ） months respectively. Conclusions Patients with local recurrence of rectal cancer should still be given aggressive operative treatment. Radical resection of the lesions and formal radical lymphadenectomy can prolong patient survival time and improve quality of life.