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目的 探讨大肠癌术后复发的原因及诊断和治疗方法。方法 回顾性分析 1998～ 2 0 0 2年 4 6例 (4 8处 )大肠癌术后复发的原因。结果 吻合口处复发 13例 ,盆腔内复发 15例 ,会阴部复发 6例 ,肝脏转移 7例 ,腹腔内复发 7例。手术后 2年内复发 35例 (76 % )。本组病例均再次行手术治疗 ,其中 2 8例直肠癌和 18例结肠癌根治性切除率分别为 5 4 % (15 /2 8)和 6 7% (12 /18) ,姑息性切除率分别为 4 6 % (13/2 8)和 33% (6 /18)。结论 首次手术应根据大肠癌生物学特点 ,制定合理的以手术为主的综合治疗方案。切除足够的肠管、彻底清除淋巴结及其所在的肠系膜、杀灭微小转移灶 ,是预防大肠癌术后复发的主要措施。对复发病例应根据复发部位、病期早晚选择以手术为主的综合治疗方案。
Objective To investigate the causes of postoperative recurrence of colorectal cancer and its diagnosis and treatment. Methods The causes of postoperative recurrence of colorectal cancer in 46 cases (48 sites) from 1998 to 2002 were retrospectively analyzed. Results Anastomosis recurrence in 13 cases, 15 cases of recurrent pelvic, perineal recurrence in 6 cases, liver metastases in 7 cases, intra-abdominal recurrence in 7 cases. 35 cases (76%) relapsed within 2 years after operation. The patients in this group were treated surgically again. The radical resection rates were 28% (18/18) and 54% (18/18) respectively in 28 patients with rectal cancer and 18 patients with colon cancer. The rates of palliative resection 4 6% (13/2 8) and 33% (6/18). Conclusions The first operation should be based on the biological characteristics of colorectal cancer, to develop a reasonable surgery-based comprehensive treatment. Excision of enough intestine, complete removal of the lymph nodes and mesentery where they are located, to kill micro-metastases, is to prevent the recurrence of colorectal cancer after the main measures. The recurrence of cases should be based on the site of recurrence, disease early or late to choose a comprehensive surgical treatment-based programs.