| 中文关键词: 直肠肿瘤 局部复发 外科手术 适应证 禁忌证 |
| 英文关键词:rectal neoplasms local recurrence surgery indication contraindication |
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| 中文摘要: |
| 摘 要：直肠癌局部复发仍然是临床棘手的问题，对医生极具挑战性。因为其解剖及临床表现的多样性，如何诊断、分期及治疗非常复杂。根治性的挽救性切除手术仍然是治愈的唯一选择，但也要合理选择具有适应证的患者，但是这种手术难度大，并非经常施行，在过去常伴随较高的并发症及死亡率。最近因为外科技术、重建方法和围手术期并发症管理方面的进展，逐渐扩大了复发性直肠癌手术的适应证。文章主要讨论了手术技巧方面的进展，并评估了一些过去绝对禁忌证向相对适应证转变的病例报告，包括肿瘤侵犯高位骶骨和包绕髂血管的情况。 |
| 英文摘要: |
| Abstract：Locally recurrent rectal cancer remains a clinical troublesome problem and poses major therapeutic challenges. Due to variability of anatomy and clinical presentation，detection，staging，and clinical management are complex. Radical surgical salvage is the only option with potential for curative treatment and is indicated in carefully selected patients. Nevertheless，such surgery is challenging，not commonly used，and historically associated with considerable morbidity and mortality. In more recent years，improvements in surgical techniques，reconstruction methods and management of perioperative complications have expanded the options available for patients with recurrent rectal cancer. This review highlights the recent technical advance in the surgical management of locally recurrent rectal cancer，and evaluates the transition from absolute contraindication to relative contraindication，such as tumor invading high sacrum and encasing iliac vessels. |
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