直肠癌根治术后局部复发多因素分析

Multiple Factor Analysis of Local Recurrence after Radical Resection of Rectal Carcinoma

探讨直肠癌根治术后局部复发的相关因素，为直肠癌治疗提供理论根据。回顾性分析346例直肠癌根治手术病例临床资料和随访结果，比较各临床资料与复发的关系。结果显示，直肠癌术后局部复发48例（13．9％），其中合并远处转移复发29例（8．4％）；多因素分析表明，肿瘤部位，输血与否，分化程度，病理类型，Dukes分期，CEA水平，有无淋巴转移和是否行全直肠系膜切除术与术后局部复发相关，而性别、年龄、手术方式、术后化疗与否等与术后局部复发无关。结果表明，术后局部复发与病理分期晚、分化程度低、肿瘤位置低及复查时CEA水平高、有淋巴转移和未行全直肠系膜切除术有关。为预防复发宜做好首次手术，对复发病例力争早发现并给予再次手术为主的综合治疗，以延长生存期。

The objective of this study was to investigate the relative factors of local recurrence after radical resection of rectal carcinoma. Clinical and follow-up data of 346 patients undergone radical resection of rectal carcinoma were analized retrospectively. As results, local recurrence happened in 48 cases（13.9%）,of which distant metastasis and recurrence occurred in 29 cases（8.4%）. Multiple factor analysis showed that these factors of tumor location, with or without blood transfusion, cell differentiation, pathological types, Dukes staging,levels of carcinoembryonic antigen, with or without lymph metastasis and total mesorectal resection were related with local recurrence after radical resection of rectal carcinoma, while the following factors of sex,age,surgical procedure and postoperative chemical treatment were not related with local recurrence. It is concluded that postoperative local recurrence is related with such factors as late stage, low differentiation,low tumor position, high level of carcinoembryonic antigen, with lymph metastasis and failure of total mesorectal resection;successful first surgical treatment is very important. It can extend the survival time for patients that local recurrence should be early found and given reoperation-based comprehensive treatment.