复发性大肠癌再手术136例临床分析

Reoperation of 136 cases suffering from recurrence after radical resection for their large bowal cancer

为探讨Ｍｉｌｅｓ术后大肠癌复发的原因，作者分析了１３６例大肠癌根治术后复发的病例。对于复发的病例主张再手术，采用术前动脉插管化疗、放疗、免疫治疗等辅助手段，使再手术切除率达８４．５％，其中根治性切除占切除病例的９２．２％，病灶切除者５年生存率为４０．０％，根治切除者５年生存率为４４．８％。作者指出：选择不合理术式、手术残留亚临床病灶或肠外软组织浸润，如肿瘤远近端肠管及肠外组织切除不足、淋巴结清扫不彻底、会阴部切除范围较小，是Ｍｉｌｅｓ术后复发的主要原因。作者认为，远端正常肠管应切除３ｃｍ以上。特殊病例则应扩大切除，上方第三站及侧方淋巴结清除必须充分彻底。

In this report, 136 cases underwent reoperation for their local recurrence after radical resection of large bowel carcinomas. Recurrent tumours were resected in 115 of all 136 cases (84. 5% ),and among them 106 cases (92. 2% ) underwent radical resection. The five year's survival rate for thosewith palliative resection was 39. 5% and 44. 8% for those undergoing radical resection. The authors belive that local recurrence after the primary radical resection was closely related to the residual tumor tissue from inappropriate surgery and extraintestinal infiltration of the tumor.