摘要
目的通过了解直肠癌根治术(采用全系膜切除方式)后的局部复发转移规律以确定术后辅助放疗的照射野,为术后进一步治疗提供指导。方法回顾性分析了我院病理科诊断为直肠腺癌,且行根治术后,随访CT、MRI出现盆腔区域复发转移病例133例(复发时间为2000年2月至2006年4月)。复发区域划分为:①吻合口复发。②盆腔内转移或种植,包括骶前复发、直肠周围复发、盆腔淋巴结复发、盆腔种植。③会阴部复发。④腹壁、造瘘口或皮下复发。⑤其他部位复发(如骶骨、腹股沟淋巴结、髋臼、坐骨等)。根据CT及MRI显示的复发转移的每一个确切部位画点,再根据点的密集程度勾画出我们推荐的直肠癌术后预防性放疗的的大致范围。此放射野范围较传统放射范围小,称为改良野。结果133例直肠癌复发患者的中位复发时间为18个月。1年、2年及3年以内复发者分别占35.3%、68.4%及92.5%。局部复发中,盆腔内转移或种植占75.9%;吻合口复发占47.4%;腹壁、造瘘口或皮下复发占5.3%;会阴部复发占2.3%。勾画出的术后预防性照射范围小于常规照射野。结论直肠癌术后照射范围可适当缩小。
Objective This study was designed to evaluate the laws of local recurrences and metastases of postoperative rectal cancer （TME）, which confirmed the postoperative radiation fields. Methods The 133 cases of this review analysis were from rectal adenocarcinoma confirmed by pathological diagnosis after radical mastectomy. These patients＇ pelvic recurrences and metastases （from February. 2000 to April. 2006） were confirmed by CT and MRI. We devided the recurrences into 5 types. （1）Anastomotic recurrence. （2）Pelvic metastases and seeding, including not only recurrences before sacrum, around rectum and in pelvic lymph node, but also pelvic seeding. （3） Perineal recurrence. （4） Abedominal wall, artificial anus and subcutaneous recurrence. （5） Other recurrence. According to the certain recurrent position by CT and MRI, we dotted the position in pelvic anatomy map. Then we designed the postoperative radiation fields through the density of the dots. The modified fields were smaller than tradional fields. Results The median recurrent time was 18 months. The one-year, two-year and three-year recurrent rates were 35.3%, 68.4% and 92.6% respectively. Tile incidences of pelvic metastases and seeding, anastomotic recurrence, abedominal wall, artificial anus and subcutaneous recurrence and perineal recurrence were 75.9%, 47.4%, 5.3% and 2.3%. The modified fields were smaller than tradional fields. Conclusion The radiation fields for postoperative rectal cancer could be reduced properly.
