局部复发性直肠癌再手术治疗33例

目的：探讨局部复发性直肠癌再次手术治疗的疗效。方法：统计33例接受再次手术治疗的局部复发性直肠癌的临床资料，比较初次与再次手术的手术时间、出血量以及并发症，分析疗效以及影响疗效的因素。结果：33例中有23例（69．7％）行根治性切除术，10例行姑息性切除术。再次手术的手术时间长、出血多，吻合口瘘、肺部感染及伤口感染的发生率高，其中手术时间、出血量、肺部感率差异有统计学意义（P≤0．002）。全组1，2，3及4年生存率分别为96．8％、50．8％、28．6％及19．1％。根治性切除组的1，2，3及4年生存率分别为100．0％、65．4％、37．4％及24．9％，姑息性切除术组的1年和2年生存率分别为90．0％和20．0％，两组生存曲线比较差异有统计学意义（Х^2=11．038，P=0．001）。年龄及再次手术后放化疗不是影响预后的主要因素。结论：对直肠癌术后局部复发患者，只要掌握好手术指征、严格选择患者、作好围术期充分准备和相应治疗，再次手术仍然能够获得良好效果。

Surgical treatment of locally recurrent rectal carcinoma:Report of 33 cases

Objective:To investigate effect of reoperation on locally recurrent rectal carcinoma.Methods:Collected the clinical data of 33 cases with locally recurrent rectal carcinoma,made a comparision between primary operation and the second operation on operation time,blood loss and complication,analysed curative effect and in fluencing factors.Results:23(69.70%)cases accepted radical resection and 10 cases accepted palliative operation.With longer operation time and more blood loss,the second operation had a higher rate of stoma fistula,pulmonary infection and wound infection,and the differences of operation time,blood loss and pulmonary infection was statistically significant(P≤0.002).The 1-,2-,3-and 4-year survival rate of total group were 96.8%,50.8%,28.6% and 19.1% respectively.The 1-,2-,3-and 4-year survival rate of radical resection group was 100.0%,65.4%,37.4% and 24.9% respectively,the 1-and 2-year survival rate of palliative operation group was 90.0% and 20.0% respectively,the difference of survival curve in two groups was statistically significant(χ2=11.038,P=0.001).Age and postoperationary radiotherapy-chems were not main influencing factors on prognosis.Conclusion:With strict operation indication,sufficient preopera preparation and energetic therapy,surgical treatment of locally recurrent rectal carcinoma can also obtain good effect.