结肠癌与直肠癌根治术后复发的比较研究

Objective To explore the difference in tumor biological behaviors and prognosis between recurrent colon cancer and recurrent rectal cancer after radical operation. Methods Complete clinical and follow-up data of 132 patients with colorectal cancer developed recurrence,including 36 colon cancers and 96 rectal caners, after curative resection were retrospectively analyzed and compared with respect of clinical pathological features and prognosis between colon and rectal cancer.Results Significant differences were found in primary tumor gross type, histological type, tumor differentiation and lymph node metastasis between colon and rectal cancer (P＜0.05). Colon cancer recurred earlier than rectal cancer after radical surgery with the median time to recurrence being 14.0 months and 21.5 months, respectively (P=0.028). The difference in multiple sites recurrence was also found between colon (n=16,44.4%) and rectal cancer (n=65,67.7%)(P=0.014). The 3-year survival rate of recurrent rectal cancer was better than that of colon cancer (24.8% vs 15.6% ,P=0.026).Conclusion There are some differences in tumor biological behaviors between colon and rectal cancer,and the prognosis of rectal cancer with recurrence is better than that of colon cancer.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

结肠癌与直肠癌根治术后复发的比较研究

目的 探讨肿瘤根治术后复发的结肠癌与直肠癌患者生物学行为及预后差异.方法 回顾性分析132例结直肠癌（结肠癌36例,直肠癌96例）根治术后复发患者的临床资料,对其中结肠癌与直肠癌患者的临床病理特征及预后进行比较分析.结果本组结肠癌与直肠癌复发者其原发肿瘤在大体类型、组织学类型、分化程度及淋巴结转移方面的差异有统计学意义（P＜0.05）.结肠癌组与直肠癌组中位复发时间分别为14.0个月和21.5个月（P=0.028）;并分别有16例（44.4%）和65例（67.7%）多部位复发（P=0.014）;两组复发后3年生存率分别为15.6%和24.8%（P=0.026）;上述差异均有统计学意义.结论 结肠癌与直肠癌在肿瘤生物学行为上存在着一定差异,直肠癌复发患者预后优于结肠癌复发者.     

Surgery for recurrent intra-abdominal cancer

A review of 185 patients who developed recurrent intra-abdominal cancer has been undertaken to compare the results after emergency (41 patients) and elective (144 patients) surgery. The overall postoperative mortality was 19% and morbidity 45%. The mean survival was 13 +/- 20 months, median 7 months and cumulative 5-year survival 5%. The postoperative relief of symptoms was 7 +/- 18 months. A statistically significantly poorer prognosis was observed in emergency patients when compared with those operated on electively. Postoperative mortality and morbidity rates after emergency operations were 41% and 68% and after elective surgery 13% and 39%. The mean survival in the emergency group, 5 +/- 10 months, was significantly shorter than in the elective group, 17 +/- 22 months. The postoperative relief of symptoms for emergency patients was 2 +/- 3 months and for elective patients 10 +/- 22 months. Postoperative sepsis was the most common complication in the emergency group and it caused death in 9 of the 10 cases. Formation of intestinal fistula and early obstruction were the most frequent complications in the elective group. Emergency resections and bypass procedures carried the lowest risk of mortality, 33% and 11%, when compared with enterostomy and laparotomy, which were accompanied by a mortality of 61% and 50%. It is concluded that resective surgery has the best chance to improve survival in emergency surgery for recurrent cancer, although it is associated with a high risk of morbidity and mortality and a disappointingly short relief of symptoms. If resection is not feasible, the possibility of creating a bypass should be considered.     

Chronology of recurrent gastric cancer

The growth rate of 49 cases with recurrent gastric cancer was investigated with two tumor markers (AFP & CEA). The average doubling time of liver metastases (24.7 +/- 11.9 days) in 18 cases was significantly shorter from that of lymph node metastases (41.1 +/- 22.4 days) in 13 cases and of peritonitis carcinomatosa (42.2 +/- 19.6 days) in 18 cases. Latent period of recurrent cancer calculated by these doubling times was ranged from 1.0 to 3.5 years (mean 1.7 years) in liver metastases, from 1.0 to 5.0 years (mean 2.7 years) in lymph nodes metastases and from 1.5 to 6.0 years (mean 2.7 years) in peritonitis carcinomatosa. Only in liver metastases, positive correlation between the doubling time (X) and the duration of survival (Y) was observed by expressing the formula Y = 0.45 X-0.58 (R = 0.661, p less than 0.05). It is noteworthy that there is a significant correlation in spite of large differences in background subjects (systemic condition, size of metastatic lesion, etc.) and the growth rate of tumor is considered to play a very important role for determining the degree of biological malignancy of individual cancer patients in relation to survival.     

Locally recurrent rectal cancer.

Local recurrence (LR) varies from less than 4% to greater than 50%; several tumor factors and operative techniques may influence rate of LR. Of greatest interest has been the considerable inter-surgeon variation, even within the same institution. An LR rate of less than 10% has been consistently reported by those who use total mesorectal excision even without any form of adjuvant therapy, either preoperatively or postoperatively. These findings raise important questions about surgical technique, subspecialty teaching, place of adjuvant therapy and quality assurance. The management of LR by a multispecialty team and multimodality treatment including preoperative chemoradiation, surgical resection and intraoperative radiotherapy provides encouraging results in terms of better local control and prolonged survivorship in carefully selected patients. These uncontrolled results justify further evaluation of these salvage operations in a more controlled manner that should include repercussions on the quality of life of the patients.     

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目的 探讨大肠癌术后复发的原因及诊断和治疗方法。方法 回顾性分析1998～2002年46例(48处)大肠癌术后复发的原因。结果 吻合口处复发13例，盆腔内复发15例，会阴部复发6例，肝脏转移7例，腹腔内复发7例。手术后2年内复发35例(76％)。本组病例均再次行手术治疗，其中28例直肠癌和18例结肠癌根治性切除率分别为54％(15／28)和67％(12／18)，姑息性切除率分别为4696(13／28)和3396(6／18)。结论 首次手术应根据大肠癌生物学特点，制定合理的以手术为主的综合治疗方案。切除足够的肠管、彻底清除淋巴结及其所在的肠系膜、杀灭微小转移灶，是预防大肠癌术后复发的主要措施。对复发病例应根据复发部位、病期早晚选择以手术为主的综合治疗方案。