从循证医学角度谈中低位直肠癌局部复发治疗策略  

Treatment strategy of local recurrence of mid-low rectal cancer:Perspectives from evidence-based medicine

作　　者：兰平[1] 肖健[1] 柯嘉[1] 

机构地区：[1]中山大学附属第六医院,广东广州510655

出　　处：《中国实用外科杂志》2014年第9期848-851,共4页Chinese Journal of Practical Surgery

摘　　要：局部复发是中低位直肠癌治疗失败的重要原因。手术是治愈复发性直肠癌的惟一手段,多学科综合治疗可以进一步改善其预后。手术切除的完整程度对于复发直肠癌的预后有极其重要的影响,术前应行详细的影像学评估以明确可切除性。手术有许多方式,应以安全达到R0切除为目的。放疗是手术治疗的有力补充,同时也是不可切除复发直肠癌病人的重要姑息治疗手段。随着放射技术及理念的发展,盆腔再次照射的安全性问题已经得到很好的解决。与放疗同期进行的药物治疗可以进一步提高放疗的效果,术后辅助化疗亦可改善预后。药物治疗同时也是不可切除复发直肠癌的主要治疗方式。直肠癌局部复发的治疗还缺乏足够的高级别循证医学证据,临床学者依然任重道远。Local recurrence is a major reason of treatment failure for mid-low rectal cancer. Surgical resection is the only way to cure the recurrent rectal cancer. Multidisciplinary treatment could improve the prognosis. The quality of the operation is the most important prognostic factor. Detailed staging workup is required to determine the resectability. R0 resection is the objective for procedure selection.Radiotherapy is complementary to operation and effective method to palliate metastatic disease. With the progress of technique and idea of radiotherapy,the safety of re-irradiation to pelvis has been accepted. Concurrent and postoperative adjuvant chemotherapy could further improve the efficacy.Drug therapy is also the key treatment for advanced rectal cancer. The clinical evidence with high quality for relapsed rectal cancer is much in need and there is still a long way ahead.

关 键 词：循证医学 中低位直肠癌 局部复发 

分 类 号：R6[医药卫生—外科学]