结直肠癌根治术后复发的再手术治疗

摘要

目的:本文通过对结直肠癌根治术后复发转移患者的最佳治疗方式的探讨,为临床选择合理治疗方案提供理论依据。方法:回顾性分析132例结直肠癌根治术后复发转移患者的临床资料,就其中不同的处理方式对预后的影响进行分析比较。结果:本组患者确诊复发后接受再手术治疗61例(46.2%),保守治疗71例(53.8%)。再手术治疗患者的中位生存时间25.0月,3年、5年生存率分别为39.0%、26.7%,保守治疗患者的中位生存时间12.0月,3年、5年生存率分别为8.3%、0%,差异有统计学意义(?2 = 19.690,P = 0.000)。再手术治疗患者中,再次根治性手术29例,其中位生存时间45个月,3年、5年生存率分别为53.6%、47.7%,姑息性手术32例,中位生存时间仅16.0月,3年、5年生存率分别为27.5%、10.7%,差异亦具有统计学意义(?2 = 6.489,P = 0.011)。结论:结直肠癌根治术后复发转移的患者应积极争取再手术治疗,有助于延长生存期。Objective: Investigating the most effective treatment for patients with relapsed colorectal cancer after radical resection and providing clinical evidence in choosing appropriate treatment protocol. Methods: One hundred and thirty-two patients with colorectal cancer developed recurrence after curative surgery with complete clinical and fol- low-up data were retrospectively analyzed and compared with in respect of different kinds of therapies and correspond- ing prognosis. Results: Of all the 132 patients confirmed relapsing, reoperation was performed on 61 patients (46.2%, reoperation group), and conservative treatment on 71 patients (53.8%, conservation group). Survival analysis revealed that the reoperation group acquired a 25.0-month of median survival time, and its 3-year and 5-year survival rates were 39.0% and 26.7%, respectively. The results of the reoperation group were much better than those of the conservation group, with which the indexes were 12.0 months, 8.3% and 0%, respectively (?2 = 19.690, P = 0.000). In the reopera-tion group, 29 patients received radical resection, and they acquired a 45.0-month of median survival time, and its 3-year and 5-year survival rate were 53.6% and 47.7%, respectively. The other 32 patients received palliative surgery and acquired a 16.0-month of median survival time, and its 3-year and 5-year survival rate were 27.5% and 10.7%, re-spectively. The difference was significant (?2 = 6.489, P = 0.011). Conclusion: Reoperation, especially radical surgery, is suggested for colorectal cancer patients developed recurrences after radical resection in that it is helpful to prolong the survival time of these patients.