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笔者对近期内施行的大肠癌2次手术25例进行了综合分析,旨在评价术前B超或CT检查对大肠癌2次手术成功性的预测价值。男16例,女9例,平均年龄50.6岁(30~72岁),距第1次手术时间平均为1.8年(0.5~3年),Miles手术9例,其中内括约肌成形术4例,Dixon手术5例,结肠癌根治术11例。所有病人术后半年内每月行血清CEA测定和腹部B超检查,半年后改为2个月一次,一年后3个月一次,2年后每半年检查一次。将血清CEA升高或腹部B超检查阳性发现定为复发或转移。半年内复发3例,均为坚决要求保肛而行Dixon手术或内括约肌成形术,1~2年内复发或转移12例,2~3午复发或转移3例。对3午后发现肿瘤者不计入本组研究而视为肿瘤再发。22例B超或CT检查有阳性发现,3例单纯CEA升高超过正常值2倍而行剖腹探查,发现肿瘤转移。结肠癌根治术后11例,2例行姑息性切除,其余伴腹膜后广泛转移或肝转移,保留肛门的手术后病人9例中6例改行Miles手术,3例因骨盆内广泛转移而行结肠造瘘术。8例切除者2次手术后均行系统化疗及生物治疗,回顾术前检查23例血清CEA升高,13例B超或CT检查示有切除可能性,其中2次手术成功切除肿瘤8例中有6例提示有切除可能,17例2次手术失败者内有7例提示有切除可能。对2次手术成功者随访3年,5例死于肿瘤广泛转移,1例死于脑溢血,2例健在?
The author carried out a comprehensive analysis of 25 cases of colorectal cancer surgery performed recently in 25 cases, aiming to evaluate the predictive value of preoperative ultrasound or CT examination on the success of two operations of colorectal cancer. There were 16 males and 9 females with an average age of 50.6 years (30-72 years). The average time from the first operation was 1.8 years (0.5-3 years). There were 9 cases of Miles operation, including 4 cases of internal sphincterotomy, Dixon. There were 5 cases of surgery and 11 cases of colon cancer. All patients had monthly serum CEA and abdominal B-ultrasound within half a year after surgery. After half a year, they were changed to 2 months once, 3 months after 1 year, and once every 6 months after 2 years. Elevated serum CEA or abdominal B-ultrasound findings were identified as recurrence or metastasis. Within 3 months of recurrence, 3 cases were all required to maintain the anus and perform Dixon surgery or internal sphincterotomy. There were 12 cases of recurrence or metastasis within 1 to 2 years, and 3 cases of recurrence or metastasis from 2 to 3 hours. Those who discovered tumors after 3 pm were not counted in this study and considered as tumor recurrences. Twenty-two patients with positive B- or CT scans were found. In 3 patients, CEA was elevated more than twice the normal value and laparotomy was performed. Tumor metastasis was found. After radical colonic cancer in 11 cases, 2 patients underwent palliative resection and the rest had retroperitoneal metastasis or hepatic metastasis. Among the 9 patients who retained the anus, 6 of 6 patients were switched to Miles and 3 of them underwent colonic pelvic metastasis. Ostomy. Systemic chemotherapy and biotherapy were performed after 8 operations in 8 patients who underwent resection. Retrospective examination of 23 patients with elevated serum CEA and 13 B- or CT scans showed resection potential. Of these, 2 operations had successfully resection of tumor in 8 cases. There were 6 cases suggesting excision may be possible, and 7 cases of 2 cases of failure in 17 cases suggest that there is resection possible. After 2 successful follow-ups were followed up for 3 years, 5 patients died of extensive metastases, 1 died of cerebral hemorrhage, and 2 were alive.