目的

根据临床资料的回顾性分析，探讨影响直肠癌根治术后局部复发患者预后的相关因素。

方法

回顾性分析本科535 例根治性直肠癌手术病例的临床资料和随访结果，比较各临床病理因子与局部复发患者生存率的关系。Log-rank 检验初筛影响生存率的因素，Cox模型多因素分析确定影响局部复发后生存率的独立因素，Kaplan-Meier生存分析计算生存率。

结果

535 例行直肠癌根治性手术患者中，局部复发病例53例（9.91%）。首次手术至复发时间为4～54个月，中位时间12个月。其中吻合口复发9例，盆会阴复发27 例，盆会阴并远处复发17 例；无症状复发8例，有症状复发45例。肠镜检查阳性11例，阴性24 例，未行肠镜检查18例；CT检查阳性42例，阴性11例；CEA正常32例，CEA大于5 μg/L 21例；再次手术根治切除21例，姑息切除17例，探查手术6例，未行手术9例，P＜0.01。再次手术并发症率24%（13/44），3年生存率为30.78%，5年生存率为16.68%。

结论

局部复发的直肠癌能否再行根治性手术是影响其预后的独立因素，直肠癌根治术后局部复发的患者如条件允许应积极手术治疗。

Objective

To investigate the factors affected the prognosis of rectal carcinoma received radical resection,the 3 and 5-year survival rate of reoperation,based on the clinical datum analysis.

Methods

535 patients with rectal carcinoma received radical resection were analyzed retrospectively. The relationship of the clinical-pathological factors with the prognostic factors of reoperation were analyzed using log-rank analysis and the primary risk factors were obtained and multiple analysis was conducted to determinate the independent risk factors.The 3 and 5-year survival rate of reoperation were calculated based on Kaplan-Meier estimate analysis.

Results

All these 535 rectal carcinoma patients received radical resection.Local recurrence (LR)occurred in 53 cases (9.9%). The recurrence occurred 12 (4-54) months postoperatively. Radical reoperation resection were performed in 21 cases,palliative resection in 17 cases,exploration operation in 6 cases and non operation treatment in 9 cases,There were significant difference between the different surgical treatment cases (P＜0.01).The 3- and 5- year survival rates based on Kaplan-Meier estimate analysis were 30.78%, 16.68%.

Conclusions

Whether the recurrence lesion can be radically resected is an independent factor related to the prognosis and the recurrent patients whose lesion may be radically resected presents a good prognosis.If permitted,surgical resection may be performed actively for LR patients.