局部复发性直肠癌再手术治疗33例_临床医学论文.docVIP

局部复发性直肠癌再手术治疗33例_临床医学论文 局部复发性直肠癌再手术治疗33例_临床医学论文 作者：唐云波，李德福，岳现文，高炳玉 【摘要】 目的：探讨局部复发性直肠癌再次手术治疗的疗效。方法：统计33例接受再次手术治疗的局部复发性直肠癌的临床资料，比较初次与再次手术的手术时间、出血量以及并发症，分析疗效以及影响疗效的因素。结果: 33例中有23例(69.7%)行根治性切除术，10例行姑息性切除术。再次手术的手术时间长、出血多，吻合口瘘、肺部感染及伤口感染的发生率高，其中手术时间、出血量、肺部感率差异有统计学意义(P≤0.002)。全组1，2，3及4年生存率分别为96.8%、50.8%、28.6%及19.1%。根治性切除组的1，2，3及4年生存率分别为100.0%、65.4%、37.4%及24.9%，姑息性切除术组的1年和2年生存率分别为90.0%和20.0%，两组生存曲线比较差异有统计学意义(χ2=11.038，P=0.001)。年龄及再次手术后放化疗不是影响预后的主要因素。结论:对直肠癌术后局部复发患者，只要掌握好手术指征、严格选择患者、作好围术期充分准备和相应治疗，再次手术仍然能够获得良好效果。 【关键词】 直肠;癌;外科手术;再手术 　　[ABSTRACT] Objective: To investigate effect of reoperation on locally recurrent rectal carcinoma. Methods:Collected the clinical data of 33 cases with locally recurrent rectal carcinoma, made a comparision between primary operation and the second operation on operation time, blood loss and complication, analysed curative effect and in fluencing factors. Results: 23(69.70%) cases accepted radical resection and 10 cases accepted palliative operation. With longer operation time and more blood loss, the second operation had a higher rate of stoma fistula, pulmonary infection and wound infection, and the differences of operation time, blood loss and pulmonary infection was statistically significant(P≤0.002). The 1, 2, 3 and 4year survival rate of total group were 96.8%, 50.8%, 28.6% and 19.1% respectively. The 1, 2, 3 and 4year survival rate of radical resection group was 100.0%, 65.4%, 37.4% and 24.9% respectively, the 1 and 2year survival rate of palliative operation group was 90.0% and 20.0% respectively, the difference of survival curve in two groups was statistically significant(χ2=11.038, P=0.001). Age and postoperationary radiotherapychems were not main influencing factors on prognosis. Conclusion: With strict operation indication, sufficient preopera preparation and energetic therapy, surgical treatment of locally recurrent rectal carcinoma can also obtain good effect. 　　[KEY WORDS] Rectal; Carcinoma; Surgery; Resurgery 　　直肠癌的发病率