复发转移性结直肠癌的外科治疗及预后分析

背景与目的:结直肠癌是常见恶性肿瘤之一,其发病率有逐渐增高的趋势.其主要的治疗方法是根治性手术,手术后的复发及转移是导致患者死亡的主要原因.目前复发性结直肠癌的再手术是提高患者生存率和生存质量的主要方法.本文探讨结直肠癌术后复发的原因、诊断和外科治疗方法.方法:回顾性分析2003-2006年35例复发与转移性结直肠癌的外科治疗及预后.结果:手术后1年内复发者9例 (26%),3年内复发者26例(74 %).本组35例复发或转移性结直肠癌均行再次手术,7例复发性直肠癌再切除4例,造瘘3例,28例复发性结肠癌中,根治性切除8例(包括5例肝转移灶切除),姑息性切除10例,盲肠或横结肠造瘘10例.总切除率为63 %(22/35),其中根治性切除率为55%(12/22),姑息性切除45%(10/22).术后随访6～36个月,2例失访,12例根治性切除组中,9例无瘤生存,1例肺转移,2例肝转移;23例姑息治疗组中,5例死亡,4例肝转移,其余14例带瘤生存.结论:结肠癌的手术治疗,应根据其生物学特点,采取规范的手术方式、彻底清除原发灶、转移的肠系膜及淋巴结,术中注意无瘤操作,术后酌情辅以化疗或放疗,定期随访,是预防结直肠癌术后复发的主要措施.而对复发和转移病例,应根据其部位、临床特征,选择以手术为主的综合治疗方案,酌情达到根治或姑息治疗的目的.

Surgical management and prognostic analysis on recurrent colorectal carcinomas

Background and purpose:Colorectal cancer is one of the most common malignant tumors.Radical operation remains the primary treatment for the disease.Postoperative recurrence and metastases are the main cause for the patient' death.Reoperation for recurrent colorectal cancer is one of the methods to improve survival rate and quality of life for those patients.This study aimed to explore the cause,diagnosis and surgical treatment of recurrent colorectal cancer after operation.Methods:Thirty-five cases of postoperatively recurrent colorectal carcinoma who were treated from 2003 to 2006 at the Department of Surgical Oncology,2th Hospital of Jiaxing were retrospectively analyzed.Results:35 cases of colorectal cancers were re-operated and the overall rate of resection was 63 %,12 of them received radical resection with 4 recurrent rectal cancers and 8 recurrent colon cancers while others were palliatively treated.We followed up these patients from 6 to 36 months and there were 9 cases in 12 cases of radical respected group who were disease free,1 of them had lung metastases,1 liver metastases.While 23 cases in the palliative group,5 were dead,4 had liver metastases and 12 cases were alive.Of the 35 cases,26 cases(70%)tumor recurred within 3 years after first operations while others were recurrent at 1 year.Conclusions:For the patients with recurrent colorectal cancer,surgery remains one of the choices for the treatment.Multimodality treatment should be recommended for the patients at diagnosis.Completed resection of intestine with primary lesion,standard lymphadenectomy and eradicating peritoneal exfoliated cancer cells are the major steps to prevent recurrence of colorectal cancer.