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目的 分析腹膜外直肠癌根治术后早期复发转移的临床病理情况。方法 １９７４－ １９９７年间我院腹膜外直肠癌行根治术１８３例。高分化腺癌６９例，中分化腺癌６９例，低分化腺癌２２ 例，粘液腺癌１７ 例，鳞癌３例，平滑肌肉瘤３ 例。直肠外周围脂肪结缔组织浸润８４例，癌周血管瘤栓４３例，淋巴管瘤栓４５例。病变局限于粘膜层６例，侵及肌层９３ 例，淋巴结转移者７４例。结果 ２年内有局部复发及远处转移５０例，近期复发转移率为２６．８％ 。其中局部复发３４例，远处转移２２例。５０ 例复发转移患者的２ 年生存率为４６％ 。结论 对腹膜外直肠癌的预后判断，除仍应重视侵犯深度，细胞分化程度以及有无淋巴结转移等因素外，更不可忽视以下两项高危因素：１．肠外软组织浸润；２．癌周脉管侵犯。
Objective To analyze the clinicopathological features of early recurrence and metastasis after radical resection of extraperitoneal rectal cancer. Methods 183 cases of radical peritoneal carcinoma were performed in our hospital from 1974 to 1997. There were 69 well-differentiated adenocarcinomas, 69 moderately differentiated adenocarcinomas, 22 poorly-differentiated adenocarcinomas, 17 mucinous adenocarcinomas, 3 squamous cell carcinomas, and 3 leiomyosarcomas. Eighty-eight cases of perianal peripheral adipose connective tissue were infiltrated, 43 cases of peritumoral vascular tumor embolus and 45 cases of lymphangioma thrombus. Lesions were confined to the mucosa in 6 cases, invading the muscular layer in 93 cases, and lymph node metastasis in 74 cases. Results There were 50 cases of local recurrence and distant metastasis within 2 years, and the recurrence and metastasis rate was 26.8%. Among them, 34 cases had local recurrence and 22 cases had distant metastasis. The 2-year survival rate of 50 patients with recurrence and metastasis was 46%. Conclusion In addition to the factors such as depth of invasion, cell differentiation and lymph node metastasis, the following two high-risk factors should not be ignored for the prognosis of extraperitoneal rectal cancer: 1. Intestinal soft tissue infiltration; 2. Perivascular vascular invasion.