局部复发性直肠癌再手术治疗33例

Surgical treatment of locally recurrent rectal carcinoma:Report of 33 cases

目的:探讨局部复发性直肠癌再次手术治疗的疗效。方法:统计33例接受再次手术治疗的局部复发性直肠癌的临床资料,比较初次与再次手术的手术时间、出血量以及并发症,分析疗效以及影响疗效的因素。结果:33例中有23例(69.7%)行根治性切除术,10例行姑息性切除术。再次手术的手术时间长、出血多,吻合口瘘、肺部感染及伤口感染的发生率高,其中手术时间、出血量、肺部感率差异有统计学意义(P≤0.002)。全组1,2,3及4年生存率分别为96.8%、50.8%、28.6%及19.1%。根治性切除组的1,2,3及4年生存率分别为100.0%、65.4%、37.4%及24.9%,姑息性切除术组的1年和2年生存率分别为90.0%和20.0%,两组生存曲线比较差异有统计学意义(χ2=11.038,P=0.001)。年龄及再次手术后放化疗不是影响预后的主要因素。结论:对直肠癌术后局部复发患者,只要掌握好手术指征、严格选择患者、作好围术期充分准备和相应治疗,再次手术仍然能够获得良好效果。

Objective： To investigate effect of reoperation on locally recurrent rectal carcinoma. Methods：Collected the clinical data of 33 cases with locally recurrent rectal carcinoma, made a eomparision between primary operation and the second operation on operation time, blood loss and complication, analysed curative effect and in flueneing factors. Results： 23 （69.70%） cases accepted radical resection and 10 eases accepted palliative operation. With longer operation time and more blood loss, the second operation had a higher rate of stoma fistula, pulmonary infection and wound infection, and the differences of operation time, blood loss and pulmonary infection was statistically signifieant（P≤0. 002）. The 1-, 2-, 3- and 4-year survival rate of total group were 96.8%, 50. 8% , 28.6% and 19. 1% respectively. The 1-, 2-, 3- and 4-year survival rate of radical resection group was 100.0% , 65.4% , 37.4% and 24.9% respectively, the 1- and 2-year survival rate of palliative operation group was 90.0% and 20.0% respectively, the difference of survival curve in two groups was statistically signifieant（Х^2 = 11. 038, P = 0. 001 ）. Age and postoperationary radiotherapy-chems were not main influencing factors on prognosis. Conclusion： With strict operation indication, sufficient preopera preparation and energetic therapy, surgical treatment of locally recurrent rectal carcinoma can also obtain good effect.