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目的探讨中下段直肠癌根治性切除术后局部复发的危险因素。方法回顾性分析2001年12月至2003年7月广东省人民医院收治的行直肠系膜全切除的中下段直肠癌56例临床资料,采用病理大切片技术检测直肠系膜转移及环周切缘情况,分析其与局部复发的相关性,同时分析局部复发与临床病理特征的关系。结果中下段直肠癌根治性切除术后局部复发率为12.5%(7/56)。局部复发与肿瘤家族史(P=0.047)、血CEA水平(P=0.026)、癌性穿孔(P=0.004)、肿瘤分化程度(P=0.009)及脉管侵袭(P=0.001)密切相关。中下段直肠癌直肠系膜环周切缘阳性率为21.4%(12/56);环周切缘阳性的中下段直肠癌局部复发率为33.3%(4/12),明显高于环周切缘阴性的6.8%(3/44),两组差异有统计学意义(P=0.014)。中下段直肠癌直肠系膜转移率为64.3%(36/56);系膜转移阳性的中下段直肠癌局部复发率为16.7%(6/36),高于系膜转移阴性的5.0%(1/20),但两组差异无统计学意义(P=0.206)。结论肿瘤家族史、血CEA水平、癌性穿孔、肿瘤分化程度、脉管侵袭和环周切缘是中下段直肠癌根治性切除术后局部复发的重要因素。
Objective To investigate the risk factors of local recurrence after radical resection of rectal cancer in the middle and lower segments. Methods The clinical data of 56 patients with rectal mesorectal excision in the middle and lower rectal cancer treated by Guangdong Provincial People’s Hospital from December 2001 to July 2003 were analyzed retrospectively. Analyze its correlation with local recurrence, and analyze the relationship between local recurrence and clinicopathological features. Results The local recurrence rate was 12.5% (7/56) after radical resection of rectal cancer. Local recurrence was closely related to tumor family history (P = 0.047), blood CEA level (P = 0.026), cancerous perforation (P = 0.004), tumor differentiation (P = 0.009) and vessel invasion (P = 0.001). In the middle and lower rectum, the positive rate of rectal mesorectal circumferential margin was 21.4% (12/56). The local recurrence rate was 33.3% (4/12) in the middle and lower rectal cancer with a positive circumferential margin, which was significantly higher than that of the peripheral margin Negative 6.8% (3/44), the difference between the two groups was statistically significant (P = 0.014). The mesorectal mesorectal metastasis rate was 64.3% (36/56) in the middle and lower rectum. The local recurrence rate was 16.7% (6/36) in the middle and lower rectal mesangial metastasis group, which was higher than that in the mesangial metastasis negative 5.0% 20), but there was no significant difference between the two groups (P = 0.206). Conclusion The family history of cancer, blood CEA level, cancerous perforation, tumor differentiation, vascular invasion and circumferential margin are the important factors of local recurrence after radical resection of rectal cancer.