中文摘要：

目的探讨对直肠癌根治性切除术后局部复发（LRRC）患者采用再手术治疗的效果和影响患者预后的因素。方法回顾性分析1998年11月至2005年4月北京大学临床肿瘤学院收治的43例LRRC患者采用再手术治疗的临床资料，统计患者术后5年生存率、手术并发症发生率、围手术期死亡率，并用Kaplan—Meier法计算术后生存率，采用单因素分析和Cox回归模型对预后因素进行分析。结果43例患者中35例行根治性切除，8例行姑息性切除或单纯造口术。手术并发症发生率为26％（11／43），围手术期死亡率为2％（1／43），术后5年生存率为9％（4／43）。单因素分析显示，再手术方式选用根治性切除、原发肿瘤为TNMⅡ期、复发时间〈24个月、CEA水平在正常范围的患者能获得较好的预后（χ2=21．30，14．17，5．93，5．53，P〈0．05）。多因素分析中仅显示再次手术方式和原发肿瘤TNM分期是影响LRRC患者预后的独立因素（χ2=8．89，6．96，P〈0，05）。结论对于TNM分期较早的LRRC患者行根治性切除，其预后较好。

英文摘要：

Objective To assess the efficacy of surgical treatment and the prognostic factors predicting survival for patients with local recurrence of rectal cancer. Methods The clinical data of 43 rectal cancer patients who received reoperation at Beijing Cancer Hospital from November 1998 to April 2005 were retrospectively analyzed. The postoperative 5-year survival, incidence of complications, perioperative mortality were calculated. Postoperative sm＇vival was analyzed by Kaplan-Meier method and prognostic factors by univariate analysis and Cox proportional hazard regression model. Results Of all patients, 35 underwent radical resection, 8 underwent palliative resection or colostomy. The incidence of comp]ications, perioperative mortality and postoperative 5-year survival were 26% （11/43）, 2% （1/43） and 9% （4/43）, respectively. Patients who received radical resection, with primary tumor of TNM Ⅱ stage, with normal level of carcinoembryonic antigen, and with the time of recurrence within postoperative 24 months had better prognosis （χ2 = 21.30, 14. 17, 5.93, 5.53, P 〈 0.05）. Modality of reoperation and TNM staging of primary tumor were the independent factors influcing the prognosis （χ2 = 8.89, 6.96, P 〈 0.05）. Conclusion Radical resection for patients with postoperative local recurrence of rectal cancer results in a favorable prognosis.