低位直肠癌保肛术后复发的再治疗研究

Strategies of local recurrence after sphincter preserving surgery for low rectal cancer

目的探讨低位直肠癌保肛术后复发的治疗方式及疗效。方法保肛术后局部复发的低位直肠癌患者共56例，其中20例行根治手术（A组），21例行姑息手术加三维适形放射治疗（B组），15例单纯采用三维适形放射治疗（C组）。结果56例患者获随访6个月至3年，A组1、2、3年生存率分别为100．0％（20，20）、80．0％（16／20）、65．0％（13／20）；B组分别为90．5％（19／21）、52.4％（11／21）、33.3％（7，21）；C组分别为80．0％（12／15）、40．0％（6／15）、20．0％（3／15）。A组的2、3年生存率明显高于B、C组（P〈0．05）。结论对于低位直肠癌保肛术后复发的患者治疗首先应该选择根治手术．不能行根治手术的患者．可行姑息手术，术后进行三维适形放射治疗。

Objective To investigate the treatment of local recurrence after sphincter preserving surgery for low rectal cancer. Methods Fifty-six patients with local recurrence after sphincter preserving surgery for low rectal cancer were divided into three groups, 20 cases underwent radical resection （ group A ）, 21 cases underwent palliative resection combined with 3 dimensional conformal radiation therapy （group B ）, and 15 cases only received 3 dimensional conformal radiation therapy （ group C ）. Results All the patients were followed up from 6 months to 3 years. The 1-year,2-year and 3-year survival rates were 100.0% （20/20） ,80.0% （16/20） ,65.0% （13/20） in group A,90.5% （ 19/21 ）,52.4% （ 11/21 ）,33.3% （7/21） in group B and 80.0% （12/15）,40.0% （6/15）, 20.0% （3/15） in group C respectively. Both 2-year and 3-year survival rates in group A were significantly higher than those in group B and group C （P 〈 0.05 ）. Conclusions The first choice of patients with local recurrence ＂,filer sphincter preserving surgery for low rectal cancer is radical resection. Palliative resection combined with 3 dimensional conformal radiation theraov is the second choice.