直肠癌术后局部复发的再手术治病（附25例报告）

目的 探讨直肠癌术后局部复发的相关因素及再手术的价值。方法 对25例直肠癌术后局部复发的临床资料作一回顾性分析。结果 首次手术时DukdesB期10例，C期15例；行Miles术4例，Dixon术16例，Hartman术2例，结肠肛门拖出术3例。粘液腺癌12例，低分化腺癌8例，腺癌2例，绒毛状腺瘤癌变3例。肿瘤距远切缘＜3cm者16例，＞3cm者9例。再次手术时，12例行根治术，9例行姑息性手术，4例未能切除。根治术组和姑息性手术组中位生存期分别为30个月和12个月，未能切除组2．3个月。再手术5年生存率21．7％。结论 直肠癌术后局部复发与肿瘤Dckes分期、组织学类型、术后选择、术前术中“无瘤术”实施有密切关系。对直肠癌局部复发仍应积极手术，可提高病人的生存期。

Reoperation for localrecurrence after resection of rectal carcinoma(a report of 25 cases)

Objective　To explore the factors related to local recurrence after resection of rectal carcinoma and the significance of reoperation. Methods　A retrospective analysis was made on the clinical date of 25 cases who had local recurrence after resection of rectal carcinoma. Results　The primary operation revealed that 19 cases were in Dukes stage B,15 in stage C.8 cases were low-differentiated adenocarcinoma,2 adenocarcinoma and 3 malignant chang of villous adenoma. The distal incision margin from the tunor was <3 cm in 16 cases, >3cm in 9. Radical operation was performed in 12 cases, palliative opration in 9; and non-resection procedure was made in 4. The median survival time in radical operation group was 30 months, in palliative opration group 12 months, and in non-resection group 2.3 months. 5-year survival rate in reopration patients was 21.7%. Conclusions　Local recurrence after resection of rectal carcinoma is closely related to the Duckes' classification, histological type of tumor, and selection of operation.Active surgical intervention is indicated for local recurrence after resection of rectal carcinoma which can prolong the patient's survival time.