直肠癌术后局部复发综合治疗的疗效分析

目的：分析直肠癌根治术后局部复发的类型、综合治疗的疗效及预后。方法：对直肠癌术后局部复发、以往未接受过放疗的66例病人进行疗效分析。原手术方式为经腹直肠切除术45例(Dixon术40例，Parks术5例)，腹会阴直肠切除术21例。经腹直肠切除术后复发以吻合口为主(37／45，82．2％)，腹会阴直肠切除术后复发则以盆腔或会阴为主(19／21，90．5％)。复发后盆腔放疗中位剂量为40(20—64）Gy，临床症状缓解中位剂量26(10～52)Gy。其中26例在放疗过程中或之后接受过中位7个(2～12)疗程以5-FU为主的化疗。有22例放疗后获补救手术机会。结果：全组中位生存期24个月。Kaplan-Merier法计算生存率，放疗后1、3年总生存率分别为72．2％、17．9％。单因素分析并Log rank检验生存率差异，显示生存率与原发病变的期别、术后复发时间、复发部位及是否加用化疗无关，而仅与是否再次行补救手术有关。放疗后加用补救手术者3年生存期明显较长，为36．0％比8．8％(P=0．016)。结论：直肠癌根治术后局部复发者，放疗具有良好的姑息减症的作用；对部分经腹直肠切除术后的复发病例，放射治疗加补救手术能明显延长生存期。

Analysis of the Results of Combined Therapy and Outcome for Locally Recurrent Rectal Cancer

Objective: To analyze the eilects of radiotherapy with or without chemotherapy on post-operatively local recurrent rectal cancer untreated by radiotherapy previously. Methods: Of 66 patients admitted from Jan 1996 to Jun 2000, transab-dominal rectectomy were performed in 45 patients(40 by Dixon's operation, 5 by Parks' operation) and abdominoperineal rectectomy were performed in 21 patients. Anastomotic recurrence occurred mainly in cases of transabdominal rectectomy (37/45, 82.2%), and the pelvic or perineal recurrence occurred mainly in cases of abdominoperineal rectectomy (19/21, 90.5%). All the patients received radiotherapy, with a median dose of 40(20-64)Gy over 4 weeks. The symptom-controlling dose was 26(10-52)Gy. Twenty-six patients received median 7(2-12)cycles of 5-FU based chemotherapy during or after radiotherapy. Twenty-two patients underwent salvage resection following radiotherapy. Results: The median survival time was 24 months. The 1-yr and 3-yr survival rate was 72.2% and 17.9%, respectively. The results of univariate analysis showed that there was no relationship between the survival rate of the patients and pathological stage of initial primary cancer, site and interval of postoperative recurrence and combined or no chemotherapy. The rate of 3 year survival in patients performed operation after radiotherapy was higher than that in patients without operation(36.0% vs. 8.8%)(P=0.016). Conclusions: For locally recurrent rectal cancer, radiotherapy alone can achieve ideal local-regional palliative effect. Salvage surgery following radiotherapy may be helpful to prolong survival in a selected group of abdominal resection patients.