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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 explore the local recurrence form of rectal cancer and its causes to improve its therapeutic effect. Methods Retrospective analysis of the recurrent cases of recurrence after 1975 ~ 2001 recurred form, the causes and treatment. Results Local postoperative recurrence was 207 cases, accounting for 81% of all the rectal cancers in the same period (2538 cases). Among the local recurrence forms, the first Miles operation (102 cases) was mostly recurrence of perineum and presacral space , 52 cases (51%). Another 22 cases of vaginal wall recurrence. After the first Dixon operation, the anastomosis and its surrounding tissues were relapsed, with 71 cases and 65 cases, accounting for 87.7% (71/81) and 80 2% (65/81), respectively. Recurrence of lymph node metastasis was 55 cases, accounting for 26.6% (55/27). The recurrence was due to inadequate bowel resection, lack of tissue clearance around the primary tumor, inadequate perineal resection and inadequate lymph node dissection To The rate of resection was 6 6 1% (137/2 0 7), of which 6 3 (46%) achieved clinical cure. The 5-year survival rates of patients undergoing resection and radical resection were 23.3% And 34 9% respectively. Conclusion To reduce the local recurrence rate and improve the survival rate after rectal cancer, the primary tumor and its surrounding tissue must be completely excised according to the radical principle and the lymph nodes should be completely removed. For cases of recurrence, surgical treatment should be actively extended survival.