CAJ | 학술논문

目的探讨局部复发直肠癌(LRRC)患者的手术疗效及预后影响因素。方法回顾性分析1985年1月至2009年12月北京大学第一医院手术治疗的187例LRRC患者的病例资料。结果行局部切除术34例，腹会阴联合切除术35例，后盆腔脏器切除术17例，全盆腔脏器切除术(TPE)98例,TPE联合骶尾骨切除2例，TPE联合半骨盆切除1例。R0、R1、R2切除分别为87、60、40例；手术根治性与初次手术方式及盆壁受侵固定程度有关(P＜0.05)。手术并发症发生率为47.5％(89/187)，围手术期死亡率2.7％(5/187)，术后局部复发率44.4％(64/144)。144例术后3、5年生存率分别为42.2％和30.7％,手术根治性和淋巴结转移是影响预后的独立危险因素(P＜0.01)。R0、R1与R2切除者5年生存率分别为42.6％、17.2％和0(P＜0.01)；淋巴结转移阴性与阳性者5年生存率分别为40.5％与5.6％(P＜0.01)。结论术前准确评估肿瘤固定范围、提高R0切除率是提高LRRC患者手术疗效的关键。
목적 탐토국부복발직장암(LRRC)환자적수술료효급예후영향인소。방법 회고성분석1985년1월지2009년12월북경대학제일의원수술치료적187례LRRC환자적병례자료。결과 행국부절제술34례，복회음연합절제술35례，후분강장기절제술17례，전분강장기절제술(TPE)98례,TPE연합저미골절제2례，TPE연합반골분절제1례。R0、R1、R2절제분별위87、60、40례；수술근치성여초차수술방식급분벽수침고정정도유관(P＜0.05)。수술병발증발생솔위47.5％(89/187)，위수술기사망솔2.7％(5/187)，술후국부복발솔44.4％(64/144)。144례술후3、5년생존솔분별위42.2％화30.7％,수술근치성화림파결전이시영향예후적독립위험인소(P＜0.01)。R0、R1여R2절제자5년생존솔분별위42.6％、17.2％화0(P＜0.01)；림파결전이음성여양성자5년생존솔분별위40.5％여5.6％(P＜0.01)。결론 술전준학평고종류고정범위、제고R0절제솔시제고LRRC환자수술료효적관건。
Objective To evaluate the surgical outcomes for patients with locally recurrent rectal cancer (LRRC) and to analyze the prognostic factors. Methods Clinical data of 187patients with LRRC undergoing surgery at the First Hospital of peking University from January 1985 to December 2009 were retrospectively reviewed. Results Procedures performed included local resection (n =34), abdominoperineal resection (n =35 ), posterior pelvic exenteration (n =17), total pelvic exenteration(TPE, n=98), TPE with sacrectomy (n=2), and TPE with internal hemipelvectomy (n=1).The operation was R0 in 87 patients, R1 in 60, and R2 in 40. The degree of radical resection was associated with the initial surgery and the degree of pelvic fixation(P＜0.05). The pelvic recurrence rate was 44.4％(64/144). The operative morbidity and mortality were 47.5％(89/187) and 2.7％(5/187), respectively. The oveall 3- and 5-year survival rates were 42.2％ and 30.7％, respectively.The degree of radical resection and lymph node metastasis were independent risk factors associated with prognosis. The 5-year survival rates of R0, R1 and R2 were 42.6％, 17.2％ and 0, respectively (P＜0.01). The 5-year survival rates of patients with and without lymph node metastasis were 5.6％ and 40.5％ (P＜0.01) respectively. Conclusion Accurate evaluation of extent of pelvic fixation and achievement of RO resection are critical to improve the surgical outcomes for LRRC.