中国实用外科杂志

中国实用外科杂志

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手术治疗局部复发直肠癌38例临床分析

李震洋，周珉玮，顾晓冬，周易明，杨    逸，臧怡雯，孙    波，陈宗祐，项建斌   

  1. 复旦大学附属华山医院普外科，上海200040
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    分析手术治疗局部复发直肠癌（LRRC）的临床特征及预后相关风险因素。方法    回顾性分析2010年1月至2016年11月复旦大学附属华山医院普外科行手术治疗的38例LRRC病人的临床资料，均在多学科模式下行手术治疗。将病死、转移或复发病人计为预后不良，采用Logistic回归分析判断影响LRRC病人预后的风险因素。结果    手术均顺利完成，R0切除率达94.7%。3年、5年无病存活率分别为84.0%、62.0%，术后总并发症发生率为31.6%，预后不良率为23.7%。是否合并术前肠梗阻及是否行术后辅助化疗对病人预后不良率影响有统计学意义（P<0.05），其中术后辅助化疗为独立保护因素（P<0.05），而合并术前肠梗阻是独立危险因素（P<0.05）。结论  对LRRC病人实施积极手术+术后辅助治疗的综合方案能更好地改善部分病人的远期生存。

关键词: 局部复发直肠癌, 手术切除, 预后, 危险因素, 肠梗阻

Abstract:

Surgical treatment for locally recurrent rectal cancer: A clinical analysis of 38 patients        LI Zhen-yang，ZHOU Min-wei，GU Xiao-dong，et al. Department of General Surgery，Huashan Hospital of Fudan University，Shanghai 200040，China
Corresponding author：CHEN Zong-you，E-mail：zongyouchen@hotmail.com；XIANG Jian-bin，E-mail：xjbzhw@163.com
Abstract    Objective    To analyze the clinical features and prognostic factors of surgical treatment for locally recurrent rectal cancer (LRRC). Methods The clinical data of 38 patients with LRRC treated by multidisciplinary-team-based operation in Huashan Hospital of Fudan University from January 2010 to November 2016 were analyzed retrospectively. Postoperative complications and long-term outcomes were both observed retrospectively and analyzed by logistic regression to figure out the risk factors on the prognosis of LRRC patients. Disease-related mortality，recurrence or metastasis were marked and defined as poor prognosis. Results    All the surgery were completed successfully. The rate of R0 resection was 94.7%. The 3-year disease-free survival（DFS）was 84.0%，while 5-year DFS was 62.0%. The postoperative complication rate was 31.6%. During the follow-up，the poor prognosis rate was 23.7%. Preoperative intestinal obstruction and postoperative adjuvant chemotherapy affected the prognosis of the patients（P<0.05）. Multivariate analysis showed that preoperative intestinal obstruction was an independent risk factor for poor prognosis of LRRC patients，while postoperative adjuvant chemotherapy was a protective factor（P<0.05）. Conclusion    Radical surgical management and application of adjuvant chemotherapy could improve the prognosis of LRRC patients.

Key words: locally recurrent rectal cancer, surgical resection, prognosis, risk factors, intestinal obstruction