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目的 :提高对直肠癌保肛手术的认识 ,探讨保肛手术后局部复发的原因和再治疗措施。方法 :对近 6年来收治的 2 8例保肛手术后局部复发进行回顾分析。结果 :15例外 Miles手术 ,其中 1例已存活 5年 ,4例已存活 3年 ,5例术后距今不足 3年仍存活 ,均未见复发和转移 ;2年内和 1年内因广泛转移死亡各 2例 ,1例失访。 13例单纯结肠造瘘后结合规范放疗和化疗 ,2例存活 3年 ,3例术后距今不足 3年仍存活 ,2年内死亡 8例。结论 :掌握保肛原则 ,首次手术的彻底性和术后综合治疗可降低复发 ,复发后争取早期诊断 ,及时再手术 ,结合放疗、化疗可提高生存率
Objectives: To improve the understanding of anus-preserving surgery for rectal cancer, and to discuss the causes of local recurrence after anus-preserving surgery and re-treatment measures. Methods: Retrospective analysis was performed on 28 cases of local recurrence after sphincter preserving surgery in the past 6 years. RESULTS: Of the 15 Miles operations, 1 had survived 5 years, 4 had survived 3 years, 5 remained alive less than 3 years after surgery, and no recurrence or metastasis occurred; death was due to extensive metastasis within 2 years and 1 year. In 2 cases, 1 case was lost. After 13 cases of simple colostomy combined with standard radiotherapy and chemotherapy, 2 cases survived for 3 years, 3 cases survived less than 3 years after surgery, and 8 cases died within 2 years. Conclusion : To master the principle of sphincter preservation, the thoroughness of the first operation and postoperative comprehensive treatment can reduce the recurrence, and to seek early diagnosis after recurrence, timely reoperation, combined with radiotherapy and chemotherapy can improve the survival rate.