进展期直肠癌侵犯邻近脏器手术治疗184例分析

目的：探讨直肠癌侵犯邻近脏器手术切除的疗效。方法：回顾性分析我院1974年至1998手术治疗184例直肠癌侵犯邻近脏器临床资料，根治性切除124例，姑息性切除42例，单纯结肠造瘘18例。结果：术后总的1、3和5年生存率分别为85．9％、64．4％和47．9％。其中根治性切除组1、3和5年生存率分别为93．4％、80．7％和63．7％；姑息性切除组为71．7％、42．8％和25．0％；单纯造瘘组为62．5％、30．0％和12．0％。根治性切除组5年生存率显高于姑息性切除和造瘘组（P＜0．05）。结论：对直肠癌侵犯邻脏器的患，只要没有肝脏弥漫性转移、腹膜肿植和淋巴结广泛转移等不能治愈的因素，都应将直肠癌和受侵犯脏器一并切除，以达到根治的目的；对有不能治愈因素存在，则应急取切除直肠癌原发灶，术后辅以化疗和放疗，以提高生存质量和延长生存期。

Analysis of surgical resection for 184 cases with advanced rectal cancer extending to adjacent organs

Objective: To discuss the effect of surgical resection for rectal cancer extending to adjacent organs. Methods: From 1974 to 1998, 184 patients underwent surgical resection for their rectal cancer extending to adjacent organs and the clinical data were analyzed respectively. Redical rescetion was underwent in 124 cases, palliative resection was underwent in 42 cases and colostomy was used in 18 patients. Results: The 1,3 and 5-year survival rates were 85.9%, 64.4% and 47.9 respctively in all patients; in the group of redical resection, the 1, 3 and 5-year survival rates were 93.4% , 80.7% and 63.7% respectively; in the group of palliative resection, the relevant rates were 71.7%, 42.8% and 25 % respectively; and in the group of colostomy, the relevant rates were 62.5 % , 30.0 % and 15.0% respectively. The 5-year survival rate in the group of redical esection was signifiantly higher than those in the groups of palliative resection and colostomy (P<0.05). Conclusion: The resection of rectal cancer and invaded organs should be underwent if there hadn' t incurable factors (such as liver metastasis, peritoneal dissemination and widespead nodal involvement. On the other hand, the patients with incurable factors should be given palliative resection of rectal cancer combined with chemotherapy and radiotherapy postoperatvely in order to improve quality of life and prolong the survival time.