从直肠癌保肛手术局部复发的形式探讨TME 与扩大根治术的互补性

目的：从直肠癌保肛手术局部复发形式探讨TME和扩大根治术的差异和互补性。方法：分析1975年10月-2001年5月收治的术后局部复发的81例的复发形式、发生原因及治疗情况。结果：81例中，吻合口及其周围组织复发49例．局部淋巴结转移17例，多部位复发15例。改行腹会阴联合切除58例，其中合并周围脏器的全盆或后盆腔脏器切除6例：行Harimann术4例；单纯双腔造瘘12例；探查7例，手术切除率76．5％（62／81），其中32例达到临床根治．根治率39．5％（32／81）。根治切除的5年生存率是34．4％（11／32）。结论：直肠癌手术时，为防止术后局部复发，根据病情兼顾扩大根治术和TME原则．合理实施手术是关键。

Investigation on Complementarity between Total Mesorectal Excision and Radical Resection in Relation to Postoperative Local Recurrence in Patients Receiving Anus-reserve Operation on Rectal Cancer

Objective: To investigate the difference and complementarity between total mesorectal excision (TME) and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rectal cancer. Methods: Clinical data of 81 cases during a period from 1975 to 2001 were retrospectively analyzed. Results: In the 81 cases with local recurrence, 49 of them laid to anastomosises and mesorectum, 17 lymphonode and 15 multi-site relapse. The choice of operative procedure included abdominoperitoneal resection in 58 cases, Hartmann's operation in 4 cases, simple double-pelvic stoma in 12 cases, exploration in 7cases, and total pelvic or rear-pelvic resection in combination with other organs in 6 cases. The rate of resection was 84.0% (68/81). 32 cases reach clinical radical degree. The rate of radical resection is 39.5% (32/81). The 5-years surrival rate is 34.4% (11/32). Conclusion: Based on actual condition of the patients, attention for radical resection and total mesorectal excision are necessary and reasonable adoption of the operative procedure could reduce the local recurrence of rectal cancer.