直肠癌Miles术后会阴部复发原因分析

The reasons of perineum recurrence after Miles operation for rectal cancer.

目的 探讨直肠癌Miles手术后会阴部复发原因以及预防。方法 回顾性分析行直肠癌Miles手术118例 ,其中术后复发 2 1例。结果 术后复发的 2 1例中DukesC期 17例。病理类型 :分化型腺癌 17例、粘液性腺癌 3例、未分化癌 1例。肿瘤下缘距肛缘 <3cm14例、3～ 6cm4例、>6cm (最大为 8cm) 3例。手术中肠壁破裂4例。结论 病期晚、病理恶性程度高、浸润程度深、肿瘤下缘距肛缘小于 3cm、肿瘤侵及浆膜层或肠壁旁周围组织、手术中肠壁破裂以及会阴部癌旁组织清扫不彻底 ,是直肠癌Miles手术后会阴部复发主要原因。

Objective To discuss the reason of perineum recurrence and prevention after Miles operation for patients with rectal cancer.Methods 118 cases after resection for rectal cancer by Miles in our hospital from 1993 to 1998 were analysied,21 had recurrence post-operatively.Results Among the recurrent cases,Dukes C was in 17 cases,the pathological grading showed:differenciated adenocarcinoma 17 cases,mucoid adenocarcinoma 3 cases undifferentiated carcinoma 1 case.Cases with distance tumors to anus edges less than 3cm were 14,3～6cm,4 and more than 6cm(the longest is 8cm) 3.The intestinal fold discission in operation were 4 cases.Conclusion The perineum recurrence after Miles operation is closely related with various factors such as late stage cancer,high pathological grading malignancy degree,distance from tumors to anus edges less than 3cm,the tumors infiltrates serosa and the tissue of perienteric,the intestinal fold discisstion in operation and the tissue of tumors was debrided imcompletely in operation.