直肠癌前切除术后局部复发的临床分析

目的　探讨直肠癌前切除术(Dixon术)后局部复发的原因及防治策略。方法　回顾性分析1996～2 0 0 3年间178例直肠癌行Dixon术后2 6例局部复发的原因,探讨其防治策略。结果　2 6例局部复发病例中,2年内复发者2 2例(84 .6 2 % ) ,2年后复发者4例(15 .38% )。复发病灶位于吻合口及其附近者18例,骨盆及其附近者8例。根治性切除12例,姑息性切除8例,非手术治疗6例。其中位生存时间为2 8个月、10个月、8个月。结论　首次手术应严格遵循肿瘤根治原则。术中切除足够的肠管,全直肠系膜切除(TME) ,无瘤操作等是预防术后局复发的主要措施,定期随访、复查,对复发病例,应积极手术,以提高生存期,改善生活质量。

Clinical Analysis on Local Relapse after Rectal Carcinoma Resection

Objective To discuss the local relapse reason and treatment after Dixon's operation. Methods 26 cases of local relapse patients in 178 cases Dixon's operation from 1996 to 2003 were analyzed retrospectively in their reasons, treatment and prevention. Results There were 22 cases of relapse within 2 years and 4 cases after 2 years. There were 18 cases relapsed lesion located at anastomosis and nearby and 8 cases located at pelvic and nearby. The radical operation was performed in 12 cases and indulgent operation in 8 cases and non-operation in 6 cases. The mean survival rate was 28, 10 and 8 months. Conclusion The radical principle in first operation should be obeyed that enough intestine involved, TME and no-tumor performance might be main prevention for local relapse. The follow-up and active operation for relapsed cases could improve survival rate and quality.