直肠癌前切除术后吻合口复发治疗方式选择与预后分析

 目的　探讨适合直肠癌前切除术后吻合口复发的治疗方式以及不同治疗方法对预后的影响。 方法　回顾分析1999年1月至2009年12月收治的41例直肠癌前切除术后吻合口复发病例的临床资料，利用寿命表法计算中位生存时间和生存率，Kaplan-Meier法比较不同治疗方式对预后的影响，Log-rank检验差异性，以P＜0.01为有统计学意义。结果　41例中33例（80.5 %）3年内复发，中位生存时间23个月。根治手术率41.5 %（17／41），根治手术与非根治手术的中位生存时间分别为49和18个月，差异有统计学意义（χ2＝12.245，P＝0.000）。31例接受放化疗病例的中位生存期（39个月）明显优于10例未接受放化疗的病例（9个月），两组差异有统计学意义（χ2＝17.533，P＝0.000）。结论　直肠癌前切除术后吻合口复发绝大多数发生在术后3年内，根治性手术及放化疗能显著改善预后。

Suitable treatment of post operative anastomotic recurrence after anterior resection of rectal cancer and relationship between different kinds of therapy with prognosis

Objective To investigate the suitable treatment of post operative anastomotic recurrence after anterior resection of rectal cancer and analyze the relationship between different kinds of therapy with prognosis. Methods The clinical data of 41 cases of local recurrent rectal cancer after anterior resection admitted in our hospital from 1999 to 2009 were analyzed retrospectively. The median survival time and survival rate were calculated by Life Tables method. The influence of different kinds of treatment to prognosis was evaluated by Kaplan-Meier method and the variability was analyzed by Log-rank method. P <0.01 means statistical significance. Results Thirty-three (80.5 %) of 41 patients were recurrent in the first 3 years and the median survival time was 23 months. Seventeen (41.5 %) of 41 patients underwent radical R0 resection. The median survival time of radical resection patients and non-radical resection ones were 49 months and 18 months, respectively, and the difference was significant (χ2=12.245, P=0.000). Thirty-one patients with radiotherapy and/or chemotherapy showed a statistically longer median survival time than the other 10 patients without these adjuvant treatment (39 months and 9 months, respectively) (χ2=17.533, P =0.000). Conclusion Most post operative anastomotic recurrent of rectal cancer cases occurs in the first 3 years after primary surgery. Radical resection, radiotherapy and chemotherapy can improve the prognosis.