目的 探討直腸癌術后局部復發(fā)再次手術的臨床療效及影響療效的相關因素。
方法 回顧性分析2003年1月至2011年1月期間我科收治的直腸癌術后局部復發(fā)再次手術患者56例的臨床病理及部分隨訪資料,
采用χ2檢驗分析術后不同復發(fā)時間和首次不同手術方式的再次手術完整切除率,利用log-rank方法對2種再次手術方式(Dixon和Miles手術)進行生存分析。
結果 ?、僦蹦c癌術后局部復發(fā)再次手術術中出血量、手術時間均明顯多于首次手術,差異均有統(tǒng)計學意義(P<0.05)。②直腸癌根治術后5年以后局部復發(fā)者的完整切除率明顯高于直腸癌根治術后2年以內局部復發(fā)者,差異有統(tǒng)計學意義(P<0.01)。③直腸癌首次術式為Dixon術者的局部復發(fā)病灶的完整切除率明顯高于首次術式為Miles術者,差異有統(tǒng)計學意義(P<0.05)。④直腸癌術后局部復發(fā)患者再次手術為Dixon術者的中位生存時間、2年存活率及5年存活率均明顯長于或高于再次手術為Miles術者,差異均有統(tǒng)計學意義(P<0.05)。
結論 直腸癌首次手術方式不同及術后復發(fā)時間不同,可影響術后局部復發(fā)病灶再次完整切除的幾率,再次手術可作為直腸癌局部復發(fā)一種有效可行的治療方式。
引用本文: 王海江,趙澤亮,孫振強,劉林. 直腸癌局部復發(fā)的再次手術56例分析. 中國普外基礎與臨床雜志, 2013, 20(11): 1224-1227. doi: 復制
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7. | 韓加剛, 李志霞. 直腸癌的術前短期放射治療[J]. 國外醫(yī)學:外科學分冊, 2004, 31(3):164-167. |
8. | Akiyoshi T, Watanabe T, Ueno M. Is lateral pelvic lymph node dissection no longer necessary for low rectal cancer after neoadjuvant therapy and TME to reduce local recurrence?[J]. J Gastrointest Surg, 2012, 16(12):2341-2342. |
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20. | 傅傳剛, 高顯華. 局部復發(fā)直腸癌再手術適應證及手術方式的選擇[J]. 中國實用外科雜志, 2011, 31(4):287-289. |
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22. | Garcia-Aguilar J, Cromwell JW, Marra C, et al. Treatment of locally recurrent rectal cancer[J]. Dis Colon Rectum, 2001, 44(12):1743-1748. |
- 1. 陳萬青, 張思維, 鄭榮壽, 等. 中國腫瘤登記地區(qū)2007年腫瘤發(fā)病和死亡分析[J]. 中國腫瘤, 2011, 20(3):162-169.
- 2. 巫佳明, 劉桂, 鐘其生. 直腸癌術后復發(fā)再手術治療的臨床分析[J]. 中國腫瘤臨床與康復, 2005, 12(4):364-365.
- 3. 喬唐, 柏斗勝, 徐永建. 直腸癌Dixon術后局部復發(fā)原因及防治探討[J]. 實用臨床醫(yī)藥雜志, 2004, 8(2):79-80.
- 4. Baek SJ, Kim SH, Kwak JM, et al. Selective use of preoperative chemoradiotherapy for T3 rectal cancer can be justified:analysis of local recurrence[J]. World J Surg, 2013, 37(1):220-226.
- 5. Arredondo J, Baixauli J, Beorlegui C, et al. Prognosis factors for recurrence in patients with locally advanced rectal cancer preoperatively treated with chemoradiotherapy and adjuvant chemotherapy[J]. Dis Colon Rectum, 2013, 56(4):416-421.
- 6. Heald RJ, Smedh RK, Kald A, et al. Abdominoperineal excision of the rectum endangered operation[J]. Dis Colon Rectum, 1997, 40(7):747-751.
- 7. 韓加剛, 李志霞. 直腸癌的術前短期放射治療[J]. 國外醫(yī)學:外科學分冊, 2004, 31(3):164-167.
- 8. Akiyoshi T, Watanabe T, Ueno M. Is lateral pelvic lymph node dissection no longer necessary for low rectal cancer after neoadjuvant therapy and TME to reduce local recurrence?[J]. J Gastrointest Surg, 2012, 16(12):2341-2342.
- 9. Guillem JG, Paty PB, Cohen AM. Surgical treatment of colorectalcancer[J]. CA Cancer J Clin, 1997, 47(2):113-128.
- 10. Law WL, Chu KW. Resection of local recurrence of rectal cancer:results[J]. World J Surg, 2000, 24(4):486-490.
- 11. Fuyi Z, Bo Y, Zhengjia L, et al. Long term observation of 367 cases of radical excision with anus preservation by casing anastomosis in low-rectal cancers[J]. Hepatogastroenterology, 2013, 60(124):738-740.
- 12. 毛捷鴻, 李小沛. 直腸癌術后局部復發(fā)的再手術治療(附25例報告)[J]. 中國普通外科雜志, 2001, 10(3):237-240.
- 13. Melton GB, Paty PB, Boland PJ, et al. Sacral resection for recu-rrent rectal cancer:analysis of morbidity and treatment results[J]. Dis Colon Rectum, 2006, 49(8):1099-1107.
- 14. Arredondo J, Miccini M, Borghese O, et al. Anastomotic leakageand septic complications:impact on local recurrence in surgery of low rectal cancer[J]. Ann Ital Chir, 2011, 82(2):117-123.
- 15. 萬德森. 低位直腸癌保肛手術后局部復發(fā)的對策[J]. 中華胃腸外科雜志, 2010, 13(8):557-561.
- 16. Park JK, Kim YW, Hur H, et al. Prognostic factors affectingoncologic outcomes in patients with locally recurrent rectal cancer:impact of patterns of pelvic recurrence on curative resection[J]. Langenbecks Arch Surg, 2009, 394(1):71-77.
- 17. Rudmik LR, Buie WD, Heine JA. Reoperation for intraluminal rectal cancer recurrence[J]. Dis Colon Rectum, 2005, 48(9):1752-1754.
- 18. 李保衛(wèi), 申連東, 任宏. 直腸癌術后局部復發(fā)再手術50例分析[J]. 陜西醫(yī)學雜志, 2010, 39(10):1424.
- 19. Henry LR, Sigurdson E, Ross E, et al. Hydronephrosis does not preclude curative resection of pelvic recurrences after colorectal surgery[J]. Ann Surg Oncol, 2005, 12(10):786-792.
- 20. 傅傳剛, 高顯華. 局部復發(fā)直腸癌再手術適應證及手術方式的選擇[J]. 中國實用外科雜志, 2011, 31(4):287-289.
- 21. Mirnezami AH, Sagar PM. Surgery for recurrent rectal cancer:technical notes and management of complications[J]. Tech Coloproctol, 2010, 14(3):209-216.
- 22. Garcia-Aguilar J, Cromwell JW, Marra C, et al. Treatment of locally recurrent rectal cancer[J]. Dis Colon Rectum, 2001, 44(12):1743-1748.