结直肠癌复发再手术60例报告  

Reoperation for recurrent colorectal cancer:a report of 60 patients

作　　者：庞典付[1] 龚腊梅[1] 冯安明[1] 张克难[1] 

机构地区：[1]华中科技大学同济医学院附属荆州医院普通外科,湖北荆州434020

出　　处：《中国普通外科杂志》2007年第9期849-851,共3页China Journal of General Surgery

摘　　要：目的为探讨结直肠癌术后复发的原因、诊断和术后复发的治疗效果。方法笔者回顾性分析10年间收治的60例结直肠癌术后复发患者的临床资料。结果手术后2年内复发40例(66.7%)。60例中吻合口处复发15例,腹腔、盆腔内复发20例,会阴部复发10例,肝脏转移8例,腹壁切口复发7例。全组患者均再次行手术治疗,其中根治性切除38例,姑息性切除22例。再手术后的1,3,5年生存率根治性切除分别为93.6%,48.8%,36.3%;姑息性切除为54.5%,0,0。结论重视术中无瘤技术、切除足够的肠管、彻底清除淋巴结及其所在的肠系膜、消灭微小转移灶是预防结直肠癌术后复发的主要措施。对复发患者应根据复发部位、病期早晚选择以手术为主的综合治疗方案。Objective To study the causes of local recurrence, and diagnosis and treatment outcome of recurrent colorectal cancer. Methods The clinical data of 60 patients with recurrent colorectal cancer treated during 10 years in our hospital were analyzed retrospectively. Results Among the 60 cases, 40 cases （66.7 % ） had recurrence within 2 years after operation. Recurrence in anastomotic stoma, perineum, abdominal incision occurred and in the abdominal cavity and pelvic cavity in 15, 10,7 and 20 cases respectively, and liver metastases were found in 8 cases. All patients underwent reoperation including curative surgery for 38 patients and palliative operation for 22 patients. After radical reoperation the 1-, 3-, and 5-year survival rate was 93.6 % , 48.8 % , and 36.3 % , respectively, and after palliative reoperation was 54.5 % , 0 % , and 0 % , respectively. Conclusions Emphasizing the application of no-tumor touch technique, resection of adequate amount of bowel, performing complete lymphadenectomy and removal of micrometastatic lesions are the major measures to prevent recurrence of rectal cancer after operation. Integrative therapy regimens, of which surgical treatment is the major component, should be considered according to the location of recurrence and the clinical staging of the recurrent cases.

关 键 词：结直肠肿瘤 肿瘤复发/外科学 再手术 

分 类 号：R735.3[医药卫生—肿瘤]