直肠癌前切除术后吻合口复发的原因分析(附91例报告)

Cause Analysis of Stoma Recurrence after Anterior Resection of Rectal Cancer (Report of 91 Cases)

目的 探讨直肠癌前切除 (Dixon术式 )术后吻合口复发的原因及防治对策。方法 回顾性分析我院1 985～ 1 996年间所收治的 91例直肠癌前切除术后吻合口复发病例的资料。结果 对前切除术后吻合口复发患者 ,再次行根治性Miles术式 47例 ,姑息性切除 2 7例 ,单纯探查 1 1例 ,余 6例放弃手术。其中行根治性Miles术的患者术后获随访 32例 ,其 1、3、5年生存率分别为 93 %、77%和 45 %。结论 盲目扩大前切除术适应证 ,将增加术后吻合口复发率 ,直肠指检、纤维结肠镜加活检是诊断吻合口复发的主要手段 。

Objective To investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.Methods A total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourty seven patients experienced re radical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirty two cases had been followed up for 5 years and obtained 1,3,5 year survival rate for re radical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. Results One, three and five year survival rate of re radical resection (Miles) was 93%,77%,45% respectively.Conclusion To amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do re radical resection (Miles) for the patients with stoma recurrence after Dixon's operation.