直肠癌低位保肛术后局部复发的临床分析

目的探讨直肠癌低位保肛术后局部复发的原因及治疗。方法回顾性分析17例直肠癌低位保肛术后局部复发的临床病理资料。结果直肠癌低位保肛局部复发病例17例，以吻合口及周围组织复发为主，复发原因有未能保证全系膜切除、肠管切除不足、侧方淋巴结清扫不足等。复发病例中再行Miles术6例，术后1年生存率为75．0％（4例），3年生存率为33．3％（2例）。结论对低位保肛患者术前肿瘤病理类型、临床分期的判断，是减少局部复发的关键。

The Clinical Analysis of Local Recurrence of Low Rectal Carcinoma after Sphincter Preservation Operation

Objective To investigate the pathogenesis and treatment of local recurrence of low rectal carcinoma after sphincter preservation. Methods Clinical pathological data of 17 patients who underwent local recurrence after sphincter preservation for low rectal carcinoma were reviewed retrospectively. Results Of all the 17 patients who experienced local recurrence after sphincter preservation for low rectal carcinoma, anastomosis and tissue surrounding were the major recurrence. The reason consisted of following aspects, total mesorectal excision were not properly carried out, the rectum were not resected enough, the lateral lymph nodes were not sweepped adequately, and so on. 6 patients received second operations of Miles in all the recurrent cases, and the one-year survival rate was 75.0% （9, cases）, which was 33.3 % refer to three-year survival rate （2 cases）. Condusion During total mesorectal resection, surgical margin is examined by pathology. Upper and lateral lymph nodes sweeping, pathological classification and clinical stages of the tumor, all play an important role in decreasing the local recurrence rate.