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目的 探讨直肠癌术后局部复发的原因及诊断和治疗方法。方法 回顾性分析直肠癌根治术后局部复发患者 6 6例。结果 本组患者中会阴及盆腔复发 35例 ,吻合口复发 2 5例 ,阴道壁复发 6例。 4 8例 (72 .7% )手术后 2年内复发 ,35例有骶丛神经刺激症状。 4 9例再次手术切除 ,17例行局部放疗加 (或 )化疗及其它治疗。再次手术切除与非手术切除治疗 3年生存率分别为 5 9.4 %及11.8%。 5年生存率分别为 2 4 .5 %及 0。差异有显著性 (P <0 .0 1)。结论 直肠癌根治术后 2～ 3年内要严密随访 ,有利于早期发现复发。为防止局部复发 ,要严格掌握保肛指征 ,提倡行全直肠系膜切除的直肠癌根治术 ,对局部复发行再次手术切除为主的综合治疗是首选的治疗方法。
Objective To investigate the causes of postoperative local recurrence of rectal cancer and its diagnosis and treatment. Methods Sixty-six patients with local recurrence after radical resection of rectal cancer were retrospectively analyzed. Results In this group of 35 patients with perineum and pelvic recurrence, 25 cases of anastomotic recurrence, 6 cases of recurrent vaginal wall. Forty-eight (72.7%) patients relapsed within 2 years after operation, and 35 patients had symptoms of sacral plexus stimulation. 49 cases were resected surgically, 17 cases were treated with local radiotherapy and / or chemotherapy and other treatments. The 3-year survival rates after resection and non-surgical resection were 5 9.4% and 11.8% respectively. The 5-year survival rates were 24.5% and 0 respectively. The difference was significant (P <0.01). Conclusion Rectal cancer should be closely followed within 2 to 3 years after radical operation, which is conducive to the early detection of recurrence. In order to prevent local recurrence, it is necessary to strictly grasp the indications for anal anus, and to advocate radical resection of rectal cancer with total mesorectal excision, and the first comprehensive treatment of reoperation after partial resection is the preferred treatment.