盆腔脏器切除治疗局部复发直肠癌41例临床分析

摘要

Objective:To evaluate pelvic exenteration in the treatment of locally recurrent cancer(LRRC)and to analyze factors that might predict curative resection and those that affect survival.Method:Clinical data of 41 cases with LRRC receiving pelvic exenteration between 2000 and 2010 were analyzed retrospectively.Result:Of 41 cases,7 patients underwent posterior pelvic exenteration(PPE);24 underwent total pelvic exenteration(TPE), of which 5 was anus-preserving TPE.Curative resection(R0)rate is 43.9%.Morbidity and mortality were 87.8%and 0 respectively.Overall 3 and 5 years survival rate were 47.4%and 29.6%respectively.Lymph node metastasis and curative resection were correlated significantly with prognosis(P<0.05). Tumor fixation were correlated significantly with R0 resection(P<0.05).Conclusion:Surgical resection is an effective method in the treatment of LRRC, and curative resection is an important prognostic factor for survival.%　　目的：评价盆腔脏器切除术治疗局部复发直肠癌的疗效并探讨其相关预后影响因素.方法：对2000-2010年行盆腔脏器切除术治疗的41例局部复发直肠癌患者的临床资料进行回顾性分析.结果：后盆腔脏器切除术(PPE)7例，全盆腔脏器切除术(TPE)24例，其中保肛TPE 5例.R0切除率43.9%.合并症发生率87.8%，围手术期死亡率0.全组术后3、5年生存率分别为47.4%和29.6%，中位生存时间25个月.淋巴结转移与手术根治性是影响预后的主要因素(P<0.05).肿物固定程度与RO切除率显著相关(P<0.05).结论：手术切除是目前局部复发直肠癌有效的治疗方法，根治性切除可有效改善其预后.