低位直肠癌腹会阴联合切除术后局部复发43例.docVIP

精品论文 参考文献 低位直肠癌腹会阴联合切除术后局部复发43例 丁新德 冯国光通讯作者 施亚周 　　上海交通大学医学院附属新华医院崇明分院普外科 上海崇明 202150 　　【摘 要】目的：探讨低位直肠癌腹会阴联合切除术后局部复发的原因及防治方法。方法：回顾性分析1995年1月至2009年12月期间我院行低位直肠癌腹会阴联合切除术268例的临床资料。268例中局部复发43例（盆腔26例、会阴部17例）。结果：低位直肠癌腹会阴联合切除术后局部复发与性别，年龄，肿瘤部位、恶性程度、Dukes分期密切相关（P＜0.05或P＜0.01）。43例中再手术17例，单纯放化疗26例。再手术17例的5年生存率为29.4%（5/17），中位生存期26.4个月（15～144个月）；单纯放化疗的26例均在3年内死亡，中位生存期11.7个月（3～29个月）。结论：低位直肠癌腹会阴联合切除术后局部复发与多因素综合作用结果相关。预防术后局部复发关键是做好首次手术。复发病例力争早发现，并予以积极再手术为主的综合治疗，可延长患者生存期。 　　【关键词】直肠癌；腹会阴联合切除术；局部复发；再手术；辅助化疗；放疗 　　【中图分类号】R735.37 【文献标识码】B 【文章编号】1674-8999（2015）8-0178-02 　　local recurrence of 43 cases of 　　low rectal cancer after abdominoperineal resection 　　Ding Xinde, Feng Guoguang, Shi Yazhou 　　( Department of General Surgery, Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 202150, China ) 　　【Abstract】Objective：To investigate the causes and prevention and treatment methods of local recurrence after abdominoperineal resection (APR) for low rectal cancer. Methools：The clinical data of 268 patients with low rectal carcinoma undergone APR from 1995 January to 2009 December in our hospital were reviewed retrospectively. Among them, local recurrence occurred in 43 cases (26 cases of pelvic, 17 cases of perineum). Results：The local recurrence after APR is closely related to the gender, age, tumor location, malignant degree, Dukes stage（P＜0.05 or P＜0.01）. 17 cases were reoperation and 26 cases were only radiotherapy and chemotherapy.The 5-year survival rate was 29.4% (5/17) and the median survival time was 26.4 months (15～144months) for 17 cases of reoperation. 26 cases of unoperation died in 3 years, their median survival time was 11.7 months (3～29months). Conclusion：The local recurrence of low rectal cancer after APR is related to the comprehensive effect of multiple factors . The key to prevent postoperative local recurrence is that tumor should be resected completely for the first time. The recurrence cases should be detected as soon as poss