低位直肠癌术前放化疗或单纯放疗加前切除术与Miles手术远期疗效对比  

Comparison of long-term efficacy between preoperative radiotherapy or radiochemotherapy followed by lower-aterior resection and Miles abdominoperineal resection in patients with low rectal cancer

作　　者：刘建东[1] 杜同海[2] 刘丽岩[3] 魏文杰[1] 

机构地区：[1]北京市普仁医院(原北京市第四医院)外科,100062 [2]河北省邯郸铁路医院外科 [3]河北省邯郸市第一医院外科

出　　处：《中华胃肠外科杂志》2005年第4期297-300,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的分析局部进展期低位直肠癌术前放化疗加前切除术或术前放疗加前切除术与Miles手术的远期效果。方法157例低位直肠癌患者为1983年1月至2000年12月收治,原发肿瘤距肛门中位距离6.1cm,临床分期Ⅱ期69例,Ⅲ期88例(TNM,UICC)。放疗方法为术前直线加速器的盆腔四野照射,35～45Gy/4～5周;化疗方法为以氟尿嘧啶为主的联合化疗。予以术前放、化疗加前切除术52例(A组);术前单纯放疗加前切除术51例(B组);单纯Miles手术54例(C组)。对全部患者的临床资料和随访结果进行回顾性分析。结果本组随访率91.7%。5年生存率A组71.1%,B组47.1%,C组42.6%;A组明显高于B和C组(P<0.05)。无瘤生存率A组61.5%,B组37.3%,C组35.2%;A组仍明显高于B和C组(P<0.05)。局部复发率A组13.5%,B组15.7%,C组11.1%;3组之间差异无统计学意义(P>0.05)。远处转移率(包括局部复发加远处转移)A组23.1%,B组49.0%,C组46.3%;A组明显低于B和C组(P<0.05)。但B组与C组的差异无统计学意义(P>0.05)。结论术前放、化疗加前切除手术治疗低位直肠癌的方法可改善5年生存率和无瘤生存率,降低远处转移率。Objective To compare the long- term efficiency between preoperative radiotherapy or radiochemotherapy followed by lower- anterior resection and abdominoperineal resection(APR) for lower and locally advanced rectal cancer. Methods From January 1983 to December 2000,157 consecutive patients suffering from lower rectal cancer were enrolled in the study,which included 69 cases of clinical stage Ⅱ and 88 cases of stage Ⅲ respectively. All patients were divided into three groups. Patients in group A(n=52) received preoperative radiotherapy with a total dose of 35～ 45 Gy within 4～ 5 weeks plus preoperative chemotherapy with 5- fluorouracil(5- FU) followed by lower- anterior resection; patients in group B(n=51) received radiotherapy followed by lower- anterior resection; patients in group C(n=54) received APR only. Clinical data of all patients were reviewed retrospectively. Results The follow- up rate was 91.7% . The 5- year survival rate was higher in group A(71.1% ) than those in group B(47.1% ) and group C(42.6% )( P< 0.05) . The tumor- free survival rate was higher in group A(61.5% ) than those in group B(37.3% ) and group C(35.2% )( P< 0.05) . The local recurrence rate was 13.5% ,15.7% and 11.1% in group A,B and C respectively,there was no significant difference in recurrence rate among three groups(P >0.05). The distant metastasis rate was lower in group A(23.1% ) than those in group B(49.0% ) and group C(46.3% )( P< 0.05) ,but there was no significant difference in distant metastasis rate between group B and group C. Conclusions The combined preoperative radiochemotherapy followed by lower- anterior resection can improve the 5- year survival rate and tumor- free survival rate,and decrease distal metastasis rate.

关 键 词：MILES手术 低位直肠癌 前切除术 术前放化疗 单纯放疗 远期疗效对比 5年生存率 无瘤生存率 远处转移率 局部进展期 2000年 1983年 直肠癌患者 直线加速器 回顾性分析 局部复发率 远期效果 术前放疗 原发肿瘤 临床分期 联合化疗 

分 类 号：R735.37[医药卫生—肿瘤] R735.1[医药卫生—临床医学]