直肠癌术后局部复发形式及其治疗

Patterns and treatment of local recurrence after rectal carcinoma operation.

目的 探讨直肠癌局部复发形式、原因 ,以提高其治疗效果。方法 回顾性分析 1975～ 2 0 0 1年间收治的术后局部复发病例的复发形式、发生的原因及其治疗情况。结果 术后局部复发 2 0 7例 ,占同期全部直肠癌(2 5 38例 )的 8 1% ,局部复发形式中 ,首次Miles手术者 (10 2例 )多为会阴部及骶前腔的复发 ,为 5 2例 (5 1% )。另外 2 2例为阴道壁复发。首次Dixon手术后主要为吻合口及其周围组织的复发 ,分别为 71例及 6 5例 ,占87 7% (71/ 81)及 80 2 % (6 5 / 81)。淋巴结转移癌的复发为 5 5例 ,占 2 6 6 % (5 5 / 2 0 7) ,复发是由于肠管切除不足 ,原发灶周围组织清除不足 ,会阴部组织切除不足及淋巴结切除范围不足所致。复发病例再次手术切除率为6 6 1% (137/ 2 0 7) ,其中的 6 3例 (46 % )达到了临床根治程度 ,病变切除及根治切除者 5年生存率分别为 2 3 3%及34 9%。结论 欲降低直肠癌术后局部复发率和提高生存率 ,必须按根治原则彻底切除原发灶及其周围组织 ,并彻底清除淋巴结。对于复发病例 ,应积极进行手术治疗 ,可延长生存期。

Objective To discuss the local recurrence patterns and causes of rectal carcinoma, and to improve the treatment effects. Methods Retrospectively analyzed the recurrence patterns, causes and treatment of the local recurrent cases of rectal carcinomas after operation that were admitted from 1975 to 2001. Results There were 207 cases (207/2538, 8.1%) of local recurrence. In 102 patients who received Miles operation, 52 patients (51%) got local recurrence in perineum and presacral region, 22 patients in vaginal wall. In 81 patients who received Dixon operations, 71 patients (87.7%) got local recurrence in stoma, and 65 patients (80.2%) in surrounding tissues. Recurrence of lymph nodes metastasis occurred in 55 cases (55/207, 26.6%). The rate of reoperative resection in local recurrence cases was 66.1% (137/207), of which, 46%(63/137)received radical resection. The 5-year survival rate in recurrent lesion resection group and radical resection group were 23.3% and 34.9% respectively. Conclusion To decrease the postoperative local recurrence of rectal carcinoma and increase the survival rate, primary lesion and surrounding tissues must be radically resected, lymphadenectomy should be performed thoroughly. In case of recurrence, surgical treatment should be done to increase survival time.