直肠癌术后局部复发的外科治疗

Surgical treatment for local recurrence of rectal carcinoma after operation

目的探讨直肠癌术后复发再手术的价值。方法对直肠癌术后局部复发接受再手术治疗的62例患者的临床资料进行回顾性分析。结果62例中有32例（51.6%）获根治性切除,其中16例行联合脏器切除;6例获姑息性肿块切除手术;单纯造口11例;单纯剖腹探查13例。术后超过5年局部复发者其肿瘤切除率为100%（11/11）;术后2年内复发者切除率为62.9%（22/35）;术后超过2年、但在5年以内局部复发者,肿瘤切除率为31.3%（5/16）;差异有统计学意义（χ^2=13.07,P〈0.01）。单纯局部复发者肿瘤切除率为80.0%（32/40）;局部复发伴有附近脏器侵犯者肿瘤切除率为27.3%（6/22）;差异有统计学意义（P〈0.01）。首次术式为Dixon根治术者,再手术的肿瘤切除率为61.9%（26/42）;首次术式为Miles根治术者,再手术的肿瘤切除率为30.0%（6/20）;两组的肿瘤切除率比较,差异有统计学意义（P〈0.01）。获根治性切除病例术后1、3、5年生存率分别为90.6%、59.4%和18.8%;姑息性手术及其他治疗者生存时间为2-24个月,中位生存期为15个月;差异有统计学意义（P〈0.01）。结论直肠癌患者术后复发再手术可以延长生存期。

Objective To evaluate the value of reoperation for local recurrence of rectal carcinoma. Methods The data of 62 cases with post-operative local recurrence of rectal carcinoma were analyzed retrospectively. Results All the 62 patients received reoperation. Thirty two of those patients were treated with radical resection （16 patients combined multiple organ resection）, 6 palliative resection, 11 colonstomy, and 13 laparatomy only. The 1-, 3-and 5-year survival rates in the patients accepted radical resection were 90.6%, 59.4% and 18.8% respectively. But in patients undergone palliative resection and combined therapy, survival time was 6-24 months with median survival time of 16 months. The patients, accepted laparatomy and intra-abdominal chemotherapy, all died within 2-14 months postoperatively. For patients with postoperative recurrence time 〉5 years, 〈2 years and 2-5 years, the reoperation resection rates were 100%（11/11）, 62.9%（22/35）, and 31.3%（5/16） respectively, and there were significant differences among 3 groups （P〈0.01）. The rate of reoperation resection of pure local recurrence was 80.0%（32/40）. The rate of reoperation resection of local recurrence, associated with near organ invasion, was 27.3%（6/22）. The difference was significant（P〈0.01）. The reoperation resection rate of first operation with Dixon or Miles was 61.9%（26/42） and 30.0%（6/20）, and the difference was significant as well（P〈0.05）. Conclusions The recurrence of rectal carcinoma still needs positive operation in order to prolong the survival time and improve the quality of life of the patient. First operative procedure, post-operative recurrence time and recurrence type are important factors of reoperative resection.