直肠癌手术后，会显现哪些部位复发，应该怎么办？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直肠癌<span style="color: black;">病人</span>，肿瘤切除以后，确实是有可能复发的，复发<span style="color: black;">能够</span>分为两种，一种是局部复发，一种是远处复发。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">复发和转移是恶性肿瘤的特征，直肠癌术后，复发和转移的概率是终生的，<span style="color: black;">然则</span>术后前五年，是复发的高峰，<span style="color: black;">尤其</span>是术后前两年。<span style="color: black;">倘若</span>手术后5年<span style="color: black;">无</span>复发和转移，<span style="color: black;">那样</span>再复发和转移的概率，就相当低了。<span style="color: black;">因此</span>，<span style="color: black;">大夫</span>经常说5年<span style="color: black;">存活</span>率，<span style="color: black;">倘若</span>术后5年<span style="color: black;">无</span>复发和转移，那就<span style="color: black;">能够</span><span style="color: black;">思虑</span>临床治愈。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天<span style="color: black;">咱们</span>就来分析一下，直肠癌<span style="color: black;">病人</span><span style="color: black;">平常</span>的复发部位，复发后<span style="color: black;">怎样</span>治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（1）局部复发</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直肠<span style="color: black;">位置于</span>盆腔，局部复发<span style="color: black;">亦</span><span style="color: black;">便是</span>在盆腔的部位，<span style="color: black;">能够</span><span style="color: black;">出现</span>在盆壁，吻合口，膀胱，子宫内，阴道等部位。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">为了降低局部复发率，外科<span style="color: black;">大夫</span><span style="color: black;">必须</span>遵守TME原则，全<span style="color: black;">叫作</span>叫做直肠全系膜切除术(total mesorectal excision，TME)。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">TME原则的<span style="color: black;">详细</span><span style="color: black;">需求</span><span style="color: black;">包含</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第1</span>，直视下锐性解剖直肠系膜<span style="color: black;">周边</span>盆筋膜壁层和脏层之间的<span style="color: black;">没</span>血管界面，<span style="color: black;">保准</span>切除标本的直肠系膜完整<span style="color: black;">没</span>撕裂。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-47f41b266190277d37614ad1513f7687_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">第二，<span style="color: black;">针对</span>中低位直肠癌：应切除肿瘤远端肠管大于等于2公分；如远切缘距肿瘤1～2 cm者，<span style="color: black;">意见</span>术中行快速冷冻切片病理学<span style="color: black;">检测</span>证实切缘阴性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">第三，切除直肠系膜远切缘距离肿瘤大于等于5 cm。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">接受TME手术的<span style="color: black;">病人</span>，复发率<span style="color: black;">明显</span>下降，<span style="color: black;">已然</span><span style="color: black;">作为</span>直肠癌根治手术的标准治疗手段。每一个结直肠癌外科<span style="color: black;">大夫</span>，都<span style="color: black;">必须</span><span style="color: black;">把握</span>TME原则，把直肠癌的复发率降到最低。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">同期</span>，<span style="color: black;">针对</span>中低位的直肠癌，手术前<span style="color: black;">必定</span>要做核磁共振<span style="color: black;">检测</span>，核磁共振<span style="color: black;">检测</span>软组织分辨率高，<span style="color: black;">能够</span><span style="color: black;">知道</span>肿瘤侵犯直肠的深度，有<span style="color: black;">无</span>侵犯血管，有<span style="color: black;">无</span>淋巴结转移。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-36962ffc302102456aeb8209b9948d3a_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">思虑</span>肿瘤<span style="color: black;">已然</span>是T3/T4，<span style="color: black;">亦</span><span style="color: black;">便是</span>肿瘤<span style="color: black;">已然</span>浸透肠壁，<span style="color: black;">或</span>侵犯了<span style="color: black;">周边</span>的组织（前列腺，膀胱，阴道等部位），<span style="color: black;">或</span>肿瘤<span style="color: black;">已然</span>有淋巴结转移，术前应该做同步放化疗，进一步降低局部复发率。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>手术前<span style="color: black;">无</span>做放化疗，术后<span style="color: black;">发掘</span>肿瘤是T3，T4<span style="color: black;">或</span>有淋巴结转移，环周切缘阳性，术后应该做放疗，降低局部复发率。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">按照</span><span style="color: black;">海量</span>的临床数据<span style="color: black;">表示</span>，经过TME手术治疗，再加上同步放化疗，直肠癌的局部复发率<span style="color: black;">已然</span>很低，<span style="color: black;">小于</span>10%。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-23a4cef5bc00a761574704bb8737e3da_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>术后局部复发了，<span style="color: black;">必须</span><span style="color: black;">按照</span>上一次的治疗方式，以及复发的严重程度，决定治疗<span style="color: black;">方法</span>。<span style="color: black;">倘若</span>能切除，<span style="color: black;">能够</span><span style="color: black;">思虑</span>再次手术切除，辅以放化疗。<span style="color: black;">倘若</span>手术切除难度大，<span style="color: black;">或</span><span style="color: black;">没</span>法切除，<span style="color: black;">能够</span>先行放化疗，<span style="color: black;">评定</span>病情变化，<span style="color: black;">倘若</span>治疗有效果，肿瘤缩小，<span style="color: black;">能够</span><span style="color: black;">评定</span>能否再次手术切除。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（2）远处复发</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">远处复发是<span style="color: black;">咱们</span>最应该关心的，直肠癌的远处转移率，与肿瘤分期，分化程度，<span style="color: black;">是不是</span>接受标准治疗都<span style="color: black;">相关</span>系。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直肠癌最常转移的部位是肝脏，除了肝脏，肺部，骨骼系统，腹股沟区，大脑等部位，都可能<span style="color: black;">显现</span>转移。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-c658c6e1b12b23aa9b94f1ec66882344_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>出现了远处转移，就属于四期的直肠癌，四期的癌症，<span style="color: black;">亦</span><span style="color: black;">便是</span><span style="color: black;">大众</span>所说的晚期，<span style="color: black;">倘若</span>转移灶较少，部位局限，<span style="color: black;">能够</span><span style="color: black;">思虑</span>手术切除<span style="color: black;">或</span>射频消融治疗，<span style="color: black;">而后</span><span style="color: black;">协同</span>化疗，有可能<span style="color: black;">得到</span><span style="color: black;">长时间</span><span style="color: black;">存活</span>，<span style="color: black;">乃至</span>是治愈。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">第二种<span style="color: black;">状况</span>是潜在可切除的转移灶，<span style="color: black;">能够</span>先行新辅助的化疗，联合靶向治疗，<span style="color: black;">定时</span><span style="color: black;">评定</span>肿瘤<span style="color: black;">针对</span>治疗的反应。<span style="color: black;">倘若</span>肿瘤对治疗有反应，效果好，<span style="color: black;">能够</span>手术切除。将<span style="color: black;">不可</span>手术的<span style="color: black;">病人</span>，变成<span style="color: black;">能够</span>手术的<span style="color: black;">病人</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-29fd5910a612328b4343c97e150d7241_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最后一种<span style="color: black;">状况</span>，<span style="color: black;">倘若</span>肿瘤多发转移，多个脏器，多个部位转移，<span style="color: black;">没</span>法手术切除，<span style="color: black;">那样</span>只能<span style="color: black;">经过</span>化疗，靶向治疗，免疫治疗等手段，延长<span style="color: black;">病人</span>的生命，延缓肿瘤的发展。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">总而言之，直肠癌<span style="color: black;">能够</span><span style="color: black;">显现</span>局部复发和远处转移，术后<span style="color: black;">必须</span><span style="color: black;">定时</span>复查， <span style="color: black;">倘若</span><span style="color: black;">初期</span><span style="color: black;">发掘</span>复发，治疗效果较好，还有治愈的<span style="color: black;">期盼</span>。（<span style="color: black;">照片</span>来自网络，侵权删）</p>
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