目的:探讨中下段直肠癌根治性切除术后局部复发的危险因素。方法:回顾性分析2001年12月至2003年7月广东省人民医院收治的行直肠系膜全切除的中下段直肠癌56例临床资料，采用病理大切片技术检测直肠系膜转移及环周切缘情况，分析其与局部复发的相关性，同时分析局部复发与临床病理特征的关系。结果:中下段直肠癌根治性切除术后局部复发率为12.5%（7/56）。局部复发与肿瘤家族史（P=0.047）、血CEA水平（P=0.026）、癌性穿孔（P=0.004）、肿瘤分化程度（P=0.009）及脉管侵袭（P=0.001）密切相关。中下段直肠癌直肠系膜环周切缘阳性率为21.4%（12/56）；环周切缘阳性的中下段直肠癌局部复发率为33.3%（4/12），明显高于环周切缘阴性的6.8%（3/44），两组差异有统计学意义（P=0.014）。中下段直肠癌直肠系膜转移率为64.3%（36/56）；系膜转移阳性的中下段直肠癌局部复发率为16.7%（6/36），高于系膜转移阴性的5.0%（1/20），但两组差异无统计学意义（P=0.206）。结论:肿瘤家族史、血CEA水平、癌性穿孔、肿瘤分化程度、脉管侵袭和环周切缘是中下段直肠癌根治性切除术后局部复发的重要因素。

Objective:The risk factors of local recurrence after curative resection were evaluated in patients with middle and lower rectal carcinoma. Methods:Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People’s Hospital were studied.The relationship between mesorectal metastasis/circumferential resection margin status and local recurrence was identified.The relationship between local recurrence and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. Results:Local recurrence after curative resection occurred in 12.5%(7/56) of patients with middle and lower rectal carcinoma.Local recurrence was associated with family history (P=0.047),high CEA level (P=0.026),cancerous perforation (P=0.004),tumor differentiation (P=0.009) and vessel cancerous emboli (P=0.001). Twelve patients (21.4%) had positive circumferential resection margin.Local recurrence rate of patients with positive circumferential resection margin was 333%(4/12),whereas it was 68%(3/44) in those with negative circumferential resection margin (P=0.014).Thirty-six (64.3%) patients was detected mesorectal metastasis.Local recurrence rate of patients with mesorectal metastasis was 16.7% (6/36),whereas it was 5.0%(1/20) in those without mesorectal metastasis.The difference between these two groups was not statistically significant (P=0.206). Conclusion:The results demonstrate that family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are significant risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma.