【作者】 赵鹏； 庄严； 岳欣； 柳建中； 董新舒； 郝希山；

【Author】 Zhao Peng Zhuang Yan Yue Xin Liu Jian-Zhong Dong Xin-Shu and Hao Xi-Shan The affiliated tumor hospital of Tianjin Medical University, Tianjin, China ( 300060 )

【机构】 天津医科大学附属肿瘤医院结直肠科；

【摘要】 目的:从直肠癌保肛手术局部复发形式探讨TME 和扩大根治术的差异和互补性。方法:回顾性分析1975年- 2001年间收治的术后局部复发的81例的复发形式、发生原因及治疗情况。结果:81例中,吻合口复发71例,吻合口周围组织(直肠系膜)复发65例,其中吻合口及直肠系膜同时复发者58例(71．6％),局部淋巴结转移17例,多部位复发15例。改行腹会阴联合切除者58例,其中合并周围脏器切除者6例,行Hartmann者4例,单纯双腔造瘘者12例, 仅行探查者7例,手术切除率76．5％(62／81),其中32例达到临床根治程度,根治率39．5％(32／81),根治切除例的5年生存率是34．4％(11／32)。结论:直肠癌手术时,为防止术后局部复发,根据病情兼顾扩大根治术和TME原则,合理实施手术是关键。更多还原

【Abstract】 Objective: To investigate the difference and complementarity between total mesorectal excision and radical resection from the postoperative local recurrence in patients who suffered from rectal cancer and received anus-reserve operation. Methods: The clinical data of 81 cases from 1975 to 2001 were retrospectively analyzed. Results: Local recurrence of 81 cases lay to anastomosises in 71cases, mesorectum in 65, both anastomosises and mesorectum in 58, lymphonode in 17 and muti-place in 15 cases. The choice of operative procedure included abdominoperitoneal resection in 58 cases, Hartmann’ s operation in 4 cases, simple double antrum stomy in 12 cases, exploration in 7cases, incorporate other organs resection in 6 cases. The rate of resection is 84.0%(68/81). 32 cases reach clinical radical degree. The rate of radical resection is 39.5%(32/81). The 5-years surrival rate is 34.4%(11/32). Conclusion: On the basis of actual condition of patients, giving attention to radical resection and total mesorectal excision principle, the adaptation of operation could reduce the local recurrence of rectal cancer.更多还原