直肠癌术后局部复发的再手术

Reoperation of local recurrent rectal cancer

目的 探讨直肠癌术后局部复发的病因、诊断、再手术及并发症的防治。方法 对 35例直肠癌术后局部复发再手术者进行回顾性分析。结果 局部复发的 35例中 13例为吻合口复发 ,11例是远切缘距肿瘤 <3cm者。 9例盆腔淋巴复发者均是首次手术时有淋巴结转移的病例 ,其中 7例未做规范的淋巴结清扫。 12例未切除全部直肠系膜。结论 局部复发与首次手术时肠管切除不足 ,淋巴清扫不彻底 ,全直肠系膜切除不够及淋巴转移有关。定期复查 ,动态观察CEA有助于复发癌的早期发现和诊断。对能耐受手术又无广泛远处转移者给予再次手术 。

Objective To investigate the pathogenesis, diagnosis , reoperation and to prevent the complication of reoperation of local recurrent rectal cancer. Methods 35 recurrent patients of post-operation of rectal cancer were analyzed. Results 13 cases of local recurrence in anastomotic mouth, 11 patients with the distance from incised edges to tumors were less than 3cm.All of 9 cases in pelvic lymph node recurrence are positive of lymph node metastasis at the first operation.7 patients were not performed standard lymph nodes dissection.Conclusion Local recurrence after the operation of rectal cancer is closely related with insufficient resection of distant normal rectum, incomplete lymph nodes dissection, failed in total mesorectal excision and positive lymph node metastasis. Regular physical check-ups and dynamic test of CEA are important to discover and diagnose the recurrence of rectal cancer in time.