首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 171 毫秒
1.
联合切除治疗晚期大肠癌有关问题探讨   总被引:3,自引:0,他引:3  
目的:探讨浸润其它器官及局部复发大肠癌联合切除的意义及手术治疗的要点。方法:回顾分析1975年7月至2001年7月收治的浸润其它器官及忆部复发大肠癌的局部浸润情况及合并切除的疗效,直接法统计生存率。结果:①联合切除作1317例结肠癌中属Dukes D期者139例,占10.5%,行联合切除者47例,占全部病例的3.6%,Dukes D期病例的33.8%;2611例直肠癌中属Dukes D期者321例占12.3%,行联合切除者127例,占全部病例的4.8%,Dukes D期病例的39.1%。②47例结肠癌患者联合切除后的5年生存率为48.9%。③直肠癌患者中行全盆腔器切除者(TPE)27例,5年生存率为40.9%,100例联合一部分器官切除一患者的5年生存率为44.0%。结论:对浸润其它器官及忆部复发大肠癌患者,不论是初发还是复发,只要患者全身条件具备,应积极采用手术治疗的方法,对延长患者的生存期有重要意义。  相似文献   

2.
保存植物神经的直肠癌根治术对排尿和性功能的影响   总被引:11,自引:0,他引:11  
目的 探讨中下段直肠癌患者行保存植物神经的肿瘤根治术对排尿和性机能的影响。方法 根据不同病情实施不同保存植物性神经的直肠癌根治术188例:Dukes A期98例,完全保存神经;B期78例,保存一侧或两侧神经;C期12例,只保存S3、4神经。结果 术后自行排尿时间平均为:A期8.5d,B期9.0d,C期16.8d。保存勃起和射精机能者:Dukes A期分别是96.9%和100%;B期是47.4%和50%;C期均为0。术后肿瘤局部复发者占12.8%(24/188),其中Dukes A、B、C期分别为4.1%、20.5%和33.3%。5年生存率Dukes A、B、C期分别是77.6%、52.6%、33.3%。结论 保存植物神经的直肠癌根治术,在不增加局部复发率和减少5年生存率的同时,可明显提高患者的生存质量。  相似文献   

3.
复发性大肠癌再手术136例临床分析   总被引:5,自引:0,他引:5  
为探讨Miles术后大肠癌复发的原因,作者分析了136例大肠癌根治术后复发的病例。对于复发的病例主张再手术,采用术前动脉插管化疗、放疗、免疫治疗等辅助手段,使再手术切除率达84.5%,其中根治性切除占切除病例的92.2%,病灶切除者5年生存率为40.0%,根治切除者5年生存率为44.8%。作者指出:选择不合理术式、手术残留亚临床病灶或肠外软组织浸润,如肿瘤远近端肠管及肠外组织切除不足、淋巴结清扫不彻底、会阴部切除范围较小,是Miles术后复发的主要原因。作者认为,远端正常肠管应切除3cm以上。特殊病例则应扩大切除,上方第三站及侧方淋巴结清除必须充分彻底。  相似文献   

4.
目的 研究进展期大肠癌根治术后应用肿瘤浸润淋巴细胞(TIL)及重组白细胞介素-2(rIL-2)联合化疗的临床治疗效果。方法 将48例Dukes B及DukesC期大肠癌患者于大肠癌根治术后采用前瞻性随机分组的方法分为2组:一组44例,术后使用自身航rIL-2联合-5氟脲嘧淀及丝裂霉素C治疗;另一组40例,术后单纯采用相同方案的化疗。随访3年。结果 TIL及rIL-2联合化疗组患者3年内局部复发率为  相似文献   

5.
报道1986年1月~1994年12月间收治直肠癌患者783例,其中,中下段直肠癌552例(占70.5%)。该552例中施行各类保肛术201例(占36.4%),其中经腹骶切除5例,经耻骨切除5例,Dixon式67例,拉下式吻合44例,拖出式吻合68例及局部切除12例。术后3年生存率达90.9%。文中就保肛手术的根治性、术后排便功能的恢复、并发症的产生和处理以及综合治疗的必要性等问题进行了分析讨论。认为保肛术是治疗中下段直肠癌的一种合理术式,其主要适用于Duke’sA和B1期病例。采取综合治疗则是预防癌肿复发和提高生存率的重要措施。  相似文献   

6.
大肠癌根治术后复发再手术136例临床分析   总被引:4,自引:0,他引:4  
作者对本院经治的136例大肠癌手术后复发患者的复发形式、范围、预防措施及再手术等进行分析探讨。作者认为,复发形式与选择不合理术式手术残留亚临床病灶或肠外软组织浸润有关;会阴部切除范围较小则是Miles术后复发的主要原因。作者提出,远端正常肠管应切除3cm以上,特殊病例则应扩大切除,上方第三站及侧方淋巴结清除必须充分彻底。对于复发的病例主张再手术,可采用术前动脉插管化疗,放射治疗,免疫治疗等辅助手段。本组采用上述方法,再手术切除率达84.5%,其中根治性切除占切除病例的92.2%,病灶切除者5年生存率为40.0%,而根治切除者5年生存率为44.8%。  相似文献   

7.
直肠癌Dixon术后局部复发60例临床分析   总被引:32,自引:2,他引:32  
目的 探讨直肠癌Dixon术后局部复发的原因。方法对近10年行Dixon术510例病人作一回顾性分析。结果 局部复发60例(11.8%),复发时间为术后3-20个月,平均8.9个月,1年内复发者45例。复发部位为吻合口46例,淋巴结5例,会阴部4例,吻合口周围3例,切口2例,属DukesA期5例,B期37例,C期18例,粘液性腺癌33例,低分化腺癌17例,印式细胞癌6例,腺癌4例。肿瘤远切缘距离〉  相似文献   

8.
青年大肠癌与老年大肠癌的比较   总被引:10,自引:0,他引:10  
顾晋  于晓军 《普外临床》1995,10(1):51-53
1975年-1990年作者共收治589例大肠癌,30岁以下31例,70岁以上50例,将两组资料进行比较发现:两均以腹痛及便血为主。但青年人就诊前病程明显长于老年人,直肠是青老年人大肠癌的好部位,青年组就诊时多为进展期且粘液癌多于老年组。Dukes分期青年组C、D期最多,老年组B期居多。青年大肠癌5年生存率为40.3%,较老年组55.3%差。  相似文献   

9.
�󳦰�������ת�Ƶ�Ԥ��������   总被引:18,自引:0,他引:18  
大肠癌早期诊断水平有了明显的提高 ,获得治愈性切除的病例逐渐增加。 5年生存率达 40 %~ 5 0 % ,但复发率仍高达 30 %~ 5 0 %。如何预防和治疗大肠癌术后复发与转移是 2 1世纪亟待研究解决的课题。1 大肠癌复发和转移的类型  切缘阳性或癌细胞在吻合口种植可导致吻合口复发。淋巴结清扫不彻底可导致局部复发。癌细胞污染腹腔、腹壁切口、造口或引流口可造成局部种植。大肠癌转移包括腹膜广泛种植转移、肝脏转移和肺转移等。2 预防策略2 1 早期诊断  大肠癌术后复发率与Dukes分期关系密切 ,DukesA期大肠癌根治性切除术…  相似文献   

10.
应用氟尿嘧啶肠腔化疗辅助结,直肠癌根治术的远期效果   总被引:16,自引:0,他引:16  
本文报告82例大肠癌随机分为两组:试验组45例,除施行根治术外。辅加肠腔5-FU化疗和术后第1、2天5-FU全身化疗;对照组37例,单纯施行根治术。Dukes’C期病人试验组3年、5年和8年生存率分别为75.5%、65.4%、和28.5%,而对照组仅58.3%、25.0%和5.6%,两者差异有显著性(P<0.05)。另外,试验组肝转移比对照组少。故此法是提高结、直肠癌根治术疗效和防止肝转移的重要措施,值得推广应用。  相似文献   

11.
目的 评价盆腔脏器联合切除术(PE)对局部进展期直肠癌的疗效。方法 对12年中79例局部进展期直肠癌PE术后结果进行回顾性总结。结果 全盆腔脏器切除术(TPE)46例,其中保肛TPE5例,TPE联合骶骨切除1例,TPE联合半骨盆切除1例,后盆腔脏器切除术(PPE)33例。根治性切除65例(82.8%),合并症发生率48.6%,手术死亡2例(2.5%),根治术后再复发36例(58.1%),术后1、3、5年生存率75.8%、39.3%、35.8%。根治性切除与大体根治切除术后3年、5年生存率分别为44.2%、40.8%与11.1%、0。结论 PE是目前治疗局部进展期直肠癌有效的方法,积极的根治性切除病灶,可以有效提高其治愈率,改善生活质量。  相似文献   

12.
BACKGROUND: After multimodal treatment estimated 5-year survival of locally recurrent rectal cancer is about 25%. Hydronephrosis secondary to pelvic recurrence of colorectal cancer is a condition claimed to represent a contraindication to surgery due to a dismal prognosis. METHODS: Prospective registration of 193 consecutive patients operated for pelvic recurrence in rectal or colon cancer from January 1991 until March 2002 at a tertiary referral hospital, 121 men and 72 women, median age 67 years, all given irradiation preoperatively. Twenty-three of 193 had hydronephrosis prior to preoperative irradiation for recurrent disease. RESULTS: R-0 stage resection was obtained in 22% of patients with hydronephrosis and in 41% without. The median survival times in patients without metastasis were 27 and 32 months, respectively, and 5-year survival rates were 11% and 25%. CONCLUSIONS: An aggressive surgical approach offers patients with pelvic recurrence from rectal and colon cancer the best potential for survival. The presence of hydronephrosis probably indicates a lower chance for complete surgical resection of the recurrence, but local control and improved survival may still be achieved, and about two thirds of patients may benefit from the operation.  相似文献   

13.
BACKGROUND: Local recurrence of rectal cancer after curative resection remains a difficult clinical problem. The aim of this study was to elucidate prognostic risk factors after resection of recurrent cancer. METHODS: Between January 1983 and December 1999, 83 patients with locally recurrent rectal cancer were studied retrospectively for survival benefit by re-resection. Sixty patients underwent resection for recurrent cancer, including total pelvic exenteration in 30 patients and sacrectomy in 23 patients. The extent of locally recurrent tumour was classified by the pattern of pelvic invasion as follows: localized, sacral invasion and lateral invasion. RESULTS: Multivariate analysis showed that the pattern of pelvic invasion was a significant prognostic factor which independently influenced survival after resection of recurrent cancer (P < 0.001). The 5-year survival rates were 38 per cent in the localized type (n = 27), 10 per cent in the sacral invasive type (n = 16) and zero in the lateral invasive type (n = 17). CONCLUSION: Resection for locally recurrent rectal cancer is potentially curative in patients with localized or sacral invasive patterns of recurrence. Alternatives should be explored in patients with recurrence involving the lateral pelvic wall.  相似文献   

14.
应用盆腔脏器联合切除术治疗局部复发型直肠癌   总被引:9,自引:0,他引:9  
目的 评价盆腔脏器联合切除术对局部复发型直肠癌的治疗意义。方法 对我院33例局部复发型直肠癌应用盆腔脏器联合切除术治疗的病例进行回顾性总结。结果 33例患中17例接受全盆腔脏器切除术治疗,14例接受后盆腔脏器切除术;2例为直肠癌合并输尿管下段切除。29例(87.9%)手术为根治术,手术死亡率3.0%。盆腔受累最多的器官是骶前组织和阴道。术后约88.9%的患疼痛症状消失。8例(24.2%)再次复发,并再用手术。全组2、3、4年生存率分别为36.4%、21.2%、18.2%。结论 积极的盆腔脏器联合切除术可以明显改善局部复发型直肠癌的预后,提高术后生活质量。  相似文献   

15.
16.
目的探讨新辅助治疗联合盆腔脏器切除术对复发直肠癌的临床治疗价值。方法对35例复发直肠癌患者,采用新辅助治疗方案。常规分次放疗,放疗总剂量(DT)46Gy,每周5次,每次2Gy。全身化疗2个疗程,每次予以奥沙利铂130mg/m2,第1天静脉点滴;甲酰四氢叶酸钙(CF)200mg/m2,第1~3天静脉点滴;氟脲嘧啶(5-Fu)500mg/m2,第1~3天静脉点滴。治疗结束后4~6周进行盆腔脏器切除手术。结果经新辅助治疗后,病理完全缓解6例,肿瘤平均缩小38.4%,65.7%的病例T期下降。全组无手术死亡,R0切除率为88.5%,手术并发症发生率为13.3%。本组总的3年生存率为82.8%;5年生存率为48.5%;其中获得R0切除的患者,3年生存率为90.3%,5年生存率为54.6%。结论新辅助治疗联合盆腔脏器切除术是治疗复发直肠癌的有效方法。通过降低肿瘤病期,提高手术切除率,从而提高患者生存率。  相似文献   

17.
全盆腔脏器切除术治疗直肠癌术后盆腔局部复发   总被引:3,自引:0,他引:3  
目的评价全盆腔脏器切除术(total pelvic exenteration,TPE)治疗盆腔局部复发直肠癌(locally recurrent rectal cancer,LRRC)的疗效。方法对1989-2003年行TPE治疗的35例直肠癌患者的临床资料进行分析。结果行TPE30例、保肛TPE2例、TPE联合骶、尾骨切除2例、TPE联合半骨盆切除1例。根治性切除率80%,手术死亡率3%,术后盆腔再复发率48%。全组术后5年生存率16%,根治性切除组为19%,无淋巴结转移者5年生存率24%,有淋巴结转移者为0。结论TPE手术成功的关键在于严格的适应证选择和作到真正的根治性切除。  相似文献   

18.
Two hundred fifty-five patients with colo-rectal carcinoma underwent operations in our department between January 1980 and December 1988. The five-year survival rate of stage IV patients (30 cases) was 58%, and the three-year survival rate of stage V patients (44 cases) was 8%. The study for the expression of blood group-related cancer-associated antigens (Lea, CA19-9, etc.) in colo-rectal cancers using immunohistological method and a series of mouse monoclonal antibodies revealed that the stromal staining pattern of CA19-9 means high malignancy with poor prognosis. Nineteen patients with locally invading rectal cancer were submitted to total pelvic exenteration with urinary diversion. The operative mortality rate was 5.3%. A determinate 5-year survival rate of 4.5 was achieved. Fourteen patients with local recurrent lesions of rectal cancer following abdominoperineal resection were submitted to pelvic exenteration combined with sacral resection. Two patients are alive disease free for longer than four years at this writing. This operation assures a better quality of life, lessening of symptoms, disease control and, in selected patients, a cure.  相似文献   

19.
HYPOTHESES: Vertical rectus abdominus myocutaneous flap reconstruction facilitates healing within the radiated pelvis and preserves the possibility of subsequent sexual function in patients with colorectal cancer who require partial or complete resection of the vagina. DESIGN: A retrospective review of a consecutive series of patients. SETTING: A tertiary referral center. PATIENTS: All patients undergoing surgical treatment of locally advanced or recurrent colorectal cancer and vertical rectus abdominus myocutaneous flap reconstruction of the vagina. INTERVENTION: Vertical rectus abdominus myocutaneous flap reconstruction. MAIN OUTCOME MEASURES: Operative feasibility, complications, and sexual function. RESULTS: Twelve patients underwent extended resection for primary locally advanced or recurrent colorectal cancer including total or near total vaginectomy. Median age was 47 years. Tumors included 9 rectal adenocarcinomas, 2 anal squamous cell carcinomas, and 1 recurrent cecal adenocarcinoma. Surgical procedures included 8 abdominoperineal resections with posterior exenteration; resection of pelvic tumor and partial vaginectomy in 2 patients with previous abdominoperineal resection; 1 total exenteration; and 1 total proctocolectomy with posterior exenteration. The average operative time for tumor extirpation, irradiation, and reconstruction was more than 9 hours and all patients required blood transfusions. Despite 2 patients having superficial necrosis and 4 having mild wound infections, no patient required reoperation and all achieved complete healing. Five patients reported resuming sexual intercourse. CONCLUSIONS: The vertical rectus abdominus myocutaneous flap can be successfully used for vaginal reconstruction following resection of locally advanced colorectal cancer. It provides nonirradiated, vascularized tissue that fills the pelvic dead space, allows for stomal placement, and provides a chance for sexual function.  相似文献   

20.
盆腔脏器切除术治疗复发直肠癌   总被引:19,自引:12,他引:7  
目的:探讨盆腔脏器切除术治疗复发直肠癌的疗效。方法:对1984年至2000年复发直肠癌患49例行盆腔脏器切了作术的临床资料及生存资料进行分析,结果:全组无手术死亡,R0切除率为91.8%,手术并发症发生率为12.2%,本组总的3年生存率为82.4%,5年生存率为48.7%,其中45例获得R0切除患的3年生存率为83.5%,5年生存率为59.5%,17例行全盆腔脏器切除术患的3年生存率为72.7%,5年生存率为45.5%,结论:盆腔脏器切除术是治疗复发直肠癌的有效方法,严格选择病例,确保R0切除,妥善重建泌尿和消化通道及妥善覆盖盆腔,是获得满意疗效,降低术后并发症发生率的关键。  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号