应用盆腔脏器联合切除术治疗局部复发型直肠癌

Application of pelvic exenteration for locally recurrent rectal cancer

目的评价盆腔脏器联合切除术对局部复发型直肠癌的治疗意义。方法对我院33例局部复发型直肠癌应用盆腔脏器联合切除术治疗的病例进行回顾性总结。结果33例患者中17例接受全盆腔脏器切除术治疗,14例接受后盆腔脏器切除术;2例为直肠癌合并输尿管下段切除。29例(87.9%)手术为根治性,手术死亡率3.0%。盆腔受累最多的器官是骶前组织和阴道。术后约88.9%的患者疼痛症状消失。8例(24.2%)再次复发,并再次手术。全组2、3、5年生存率分别为36.4%、21.2%、18.2%。结论积极的盆腔脏器联合切除术可以明显改善局部复发型直肠癌的预后,提高术后生活质量。

Objective To evaluate the effect of pelvic exenteration on locally recurrent rectal cancer.Methods Clinical data of 33 cases with locally recurrent rectal cancer receiving pelvic extenteration were analyzed retrospectively. Results Of 33 cases,17 patients underwent total pelvic exenteration,14 patients posterior pelvic exenteration and 2 rectal cancer resection combined with lower ureter resection. Of 33 cases, 29 patients underwent radical resection. The operative mortality was 3 0%. Presacral tissue and vagina were the most frequent organs infiltrated.Severe perineal pain was relieved in 88.9% of patients .The second recurrence was found in 24.2% of patients, who underwent another resection.Survival rates at 2 , 3 , and 5 year were 36.4%, 21.2%,and 18.2% respectively. Conclusion Positive pelvic exenteration can obviously improve the prognosis and the life quality of locally recurrent rectal cancers