直肠癌根治术后局部复发多学科治疗新进展  

Advancement in multimodality therapy of local recurrent in radi- cal resection of rectal cancer

作　　者：蔡彦韬[1] 周易明[1] 陈宗祐[1] 

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《国际外科学杂志》2013年第2期120-123,共4页International Journal of Surgery

摘　　要：行直肠癌根治术的患者中，有4％～30％的患者发生局部复发。其检出与诊断，主要依靠原发肿瘤根治术后的随访、病史体检、肿瘤标志物和影像学检查。对于局部复发患者，过去以保守治疗为主，患者预后及生存质量普遍较差，手术再切除联合辅助放化疗及术前术中放疗是目前的主要治疗手段，术式选择根据复发部位、盆腔内侵犯情况而定。复发灶R0切除为手术目标，拥有相对较好的预后。对于曾接受过放疗的患者，局部复发后术前接受中等剂量的放疗是较安全的。对于不可切除的复发灶，姑息性切除以及姑息性放化疗是缓解症状改善生活质量可行的方法。After receiving radical resection of primary rectal cancer, about 4% to 30% patients would occur local recurrence. Diagnosis of local recurrence relies on postoperative follow-up, physical examina- tion, tumor markers and imageological examination. For the local recurrent patients, conservative therapeutic regimen had been popular in the past days with poor prognosis and quality of life. Nowadays nmhimodality treatment with radical resurgery combined with chemoradiotherapy and IORT has been taking the main part in the management of local recurrence. The choice of surgery depends on the site of recurrence and invasion sit- uation inside the pelvic cavity. The aim of the radical reoperation is R0 resection because it leads to an opti- mistic prognosis. Previously irradiated patients are relatively safe after receiving median-dose reirradiation. For the cases whose recurrence are unavailable for radical resection, palliative operation and chemoradiother- apy may be the wise choice to relieve their symptoms and improve the quality of life.

关 键 词：直肠肿瘤癌 肿瘤复发 局部 综合疗法 

分 类 号：R735.37[医药卫生—肿瘤]