结直肠癌术后复发模式的临床研究及再手术治疗的预后分析

Clinical study and prognosis analysis of reoperation treatment and recurrence model for postoperative recurrent colorectal carcinoma

目的总结结直肠癌术后复发模式的临床特点及规律、结直肠癌术后复发的原因,探讨复发性结直肠癌的再手术治疗的方法及预后。方法收集四川省人民医院急救中心外科2000年至2012年收治的96例结直肠癌根治术后复发患者的临床资料,根据是否伴有肝转移分为肝转移组和无肝转移组,分析结直肠癌术后复发模式的临床特点及规律,分别探讨其再手术治疗方法及预后。结果纳入标准的患者再次手术前有13例接受新辅助化疗,再次手术后接受辅助化疗41例。直肠癌术后复发45例,结肠癌术后复发51例。肝转移组76例（直肠癌术后复发29例,结肠癌术后复发47例）,无肝转移组20例（均为术后局部复发,直肠癌术后复发16例,结肠癌术后复发4例）。肝转移组中44例为单纯孤立肝转移,其中40例行根治性手术（22例为直肠癌术后复发,18例为结肠癌术后复发）,肝转移组中32例为肝内多发转移或伴有远处转移,26例行姑息性手术（3例为直肠癌术后复发,23例为结肠癌术后复发）,6例因为广泛转移放弃手术（直肠癌术后3例,结肠癌术后3例）。无肝转移组20例中有18例行根治性再次手术治疗（15例为直肠癌术后复发,3例为结肠癌术后复发）。两组中根治性切除手术58例,根治性切除率为60.4%;姑息性切除32例,姑息性切除率为33.3%。2例死于术后感染中毒性休克。术后随访6~36个月,肝转移组中根治性切除术后1、3年生存率分别为89.2%、35.6%,姑息性切除术后1、3年生存率分别为54.5%、0。无肝转移组中根治性切除术后1、3年生存率91.5%、46.9%。姑息性切除术后1、3年生存率为61.3%、12.1%。两组差异均有统计学意义（P〈0.05）。结论结肠癌患者术后复发以远处肝转移常见,直肠癌术后复发以局部复发为主。对复发性结直肠癌患者应根据是否伴有肝转移选择以再次根治性手术为主的综合治疗方案,以提高患者的生存率。

Objective To summarize the clinical character and the reason of postoperative recurrent colorectal carcinoma,investigate the methods,prognosis of reoperation for postoperative recurrent colorectal carcinoma.Methods 96 cases of postoperative recurrent colorectal carcinoma who were cured at the surgical department in the emergency center of Sichuan Province hospital from 2000 to2012 were analyzed retrospectively.Patients were divided into two groups according to liver metastasis or not.To analyze the clinical character of postoperative recurrent colorectal carcinoma,investigate the methods and prognosis of reoperation respectively.Results Neoadjuvant chemotherapy was arranged in13 cases,adjuvant chemotherapy was accepted for 41 cases.45 cases were recurrent rectum carcinoma after operation and 51 cases were recurrent colon carcinoma after operation.76 cases were liver metastasis after operation（29 cases were recurrent rectum carcinoma and 47 cases were recurrent colon carcinoma）,20 cases were non-liver metastasis after operation（16 cases were recurrent rectum carcinoma and 4 cases were recurrent colon carcinoma）.44 cases were simple isolated liver metastasis in the first group,40 cases were treated with radical operation（22 cases were recurrent rectum carcinoma and 18 cases were recurrent colon carcinoma）,32 cases were multiple liver metastasis,26 cases were treated with palliative surgery（3cases were recurrent rectum carcinoma and 23 cases were recurrent colon carcinoma）,6 cases were abandon reoperation because of metastasis generally（3 cases were recurrent rectum carcinoma and 3 cases were recurrent colon carcinoma）.18 cases were treated with radical operation in the non-liver metastasis group（15 cases were recurrent rectum carcinoma and 3 cases were recurrent colon carcinoma）.64 cases were treated with radical operation in two groups,the rate of radical operation was 60.4%;26 cases were treated with palliative surgery,the rate was 27.1%.2 cases died of postoperative septic shock.All cases were followed up 6-36 months,the 1-year and 3-year survival rate of radical operation in the liver metastasis group were 89.2%,35.6%,and the 1-year and 3-year survival rate of palliative surgery were54.5%,0 in the first group.The 1-year and 3-year survival rate of radical operation in the non-liver metastasis group were 91.5%,46.9%.There was statistical significance in two groups（P〈0.05）.Conclusions The liver metastasis occur usually after operation of colon carcinoma,but local recurrence occur usually after operation of rectal cancer.According to liver metastasis or not,the reoperation of radical surgery is the best treatment protocols for postoperative recurrent colorectal carcinoma to improve the rate of survival.