直肠前切除术后局部复发癌治疗方式选择及预后研究  

The study on treatment and prognosis of local recurrent rectal cancer after anterior resection

作　　者：陈悦[1] 刘放[1] 孟庆凯[1] 石刚[1] 

机构地区：[1]中国医科大学肿瘤医院辽宁省肿瘤医院结直肠外科,辽宁沈阳110042

出　　处：《中国实用外科杂志》2017年第9期1039-1042,1056,共5页Chinese Journal of Practical Surgery

基　　金：辽宁省科学事业公益研究基金(No.2016003002)

摘　　要：目的探讨直肠前切除术后局部复发癌的精准治疗方式。方法回顾性分析辽宁省肿瘤医院2008年2月至2014年9月收治的178例直肠前切除术后局部复发癌的临床资料,分析不同治疗方式与病人预后的关系。结果 178例病人的总生存期为(32.8±1.2)个月。根治性切除病人生存期优于姑息性切除病人[(40.8±1.4)个月vs.(27.5±1.6)个月]。直接行根治性切除与放疗后根治性切除病人生存期差异无统计学意义[(41.3±1.5)个月vs.(38.6±2.6)个月]。直接行姑息性切除和放疗后姑息性切除及造口病人,三者之间生存期差异无统计学意义[(27.8±1.6)个月vs.(25.8±4.5)个月vs.(23.9±4.9)个月]。局部复发肿瘤直接姑息性切除病人的预后好于行放化疗病人[(27.8±1.6)个月vs.(16.4±2.2)个月]。但放疗后姑息性切除病人与行放化疗病人的生存期差异无统计学意义。结论对于复发肿瘤应争取行根治性手术。如果肿瘤不可切除,应通过放化疗手段进行转化治疗后,再行根治性手术。姑息性切除手术应慎重选择,特别对于复发肿瘤放疗后仍不能达到根治性切除的病人,提示肿瘤的生物学行为不佳,治疗应以对症为主。Objective To investigate the precise treatment of local recurrenct rectal cancer after anterior resection. Methods The clinical data of 178 patients with local recurrent rectal cancer were retrospectively analyzed and correlations between different treatments and prognosis of patients were analyzed retrospectively. Results Of the 178 patients,the overall survival time was（32.8±1.2）months. The prognosis of patients performed radical resection was better than those performed palliative resection [（40.8±1.4）months vs.（27.5±1.6）months]. There was no significant difference in the survival time between the patients performed radical resection and those performed radical resection after radiotherapy [（41.3±1.5）months vs.（38.6±2.6）months]. There were also no significant differences in the survival time among the patients performed palliative resection, palliative resection after radiotherapy and colostomy [（27.8±1.6）months vs.（25.8±4.5）months vs.（23.9±4.9）months]. The prognosis of patients performed palliative resection was better than those performed radiotherapy and/or chemotherapy[（27.8±1.6）months vs.（16.4±2.2）months]. However there was no significant difference between palliative resection after radiotherapy and chemotherapy and/or radiotherapy. Conclusion The recurrence of rectal cancer should be treated with radical surgery. If the cancer could not be removed initially, radiotherapy and chemotherapy should be performed before the radical surgery. Palliative resection should be carefully chosen, especially for patients who still could not achieve radical resection after radiotherapy, which suggests that the biological behavior of the tumor is poor, and symptomatic treatment should be chosen.

关 键 词：直肠局部复发癌 治疗方式 预后 

分 类 号：R6[医药卫生—外科学]