多学科协作诊治模式下新辅助化疗干预结直肠癌手术方案的临床研究  

Intervened Colorectal Cancer Operative Strategy by Neo-Adjuvant Chemotherapy in Multi-Disciplinary Team

作　　者：汪晓东[1] 曾天芳[1] 曹霖[1] 邱萌[2] 李立[1] 

机构地区：[1]四川大学华西医院肛肠外科,成都610041 [2]四川大学华西医院肿瘤内科,成都610041

出　　处：《中国普外基础与临床杂志》2008年第6期451-454,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨在多学科协作(multi-disciplinary team,MDT)诊治模式下,新辅助化疗对结直肠癌手术方案的干预效应。方法回顾性研究2007年7月至2007年12月期间,就诊于四川大学华西医院普外科肛肠外科专业组的结直肠癌患者的资料,分析比较MDT组与非MDT组的手术预计方案与实际手术方案。结果共纳入了251例结直肠癌患者,其中直肠癌183例,结肠癌68例。MDT组和非MDT组之间基线一致,2组间术前预估手术方案差异无统计学意义(P>0.05)。分析预估施行标准根治性保肛手术的患者,发现其中术后实际手术方案无变动者所占比例及实际手术方案为扩大的根治性保肛手术者所占比例,在MDT组与非MDT组之间的差异没有统计学意义(P>0.05);而由预估的标准根治性保肛手术改为局部根治手术者所占比例,MDT组高于非MDT组,差异有统计学意义(P<0.01)。在预估施行不保肛手术的患者中,2组间比较,实际手术方案构成比差异无统计学意义(P>0.05)。2组肿瘤病灶变化,MDT组中肿瘤完全缓解和部分缓解者所占比例明显高于非MDT组,差异有统计学意义(P<0.01);但2组间T分期变化构成比差异无统计学意义(P>0.05)。结论新辅助化疗的临床价值不仅在于术前试图降低肿瘤分期,更重要的是通过联合治疗的方式为需要经由手术治疗的结直肠癌患者创造更高质量的临床效果;而新辅助化疗是否可以实现微创化手术,还需要进一步研究。Objective To explore the intervention effect on colorectal cancer operation by neo-adjuvant chemotherapy in multi-disciplinary team. Methods To analyze retrospectively the data of patients diagnosed definitely as colorectal cancer in the West China Hospital of Sichuan University from July 2007 to December 2007, and the planned and actual operative strategy were compared between MDT group and non-MDT group. Results According to the inclusion criteria, 251 colorectal cancer patients were included which had 183 rectal cancer and 68 colon cancer. The baseline between MDT group and non-MDT group was equal, and there was no difference of planned operative strategy between two groups. For patients planned undergoing standard ano-saving radical procedure, the ratio of actual procedure same to the planned and the ratio of radical procedure changed to expansive ano-saving radical procedure showed no significant differences between MDT group and non-MDT group （P〉0. 05）, whereas the difference of the ratio of radical procedure changed to local radical procedure between two groups was statistically significant （P〈0.01）. And the constituent ratio of actual procedure between two groups for patients which planned accepted non ano-saving procedure didn＇t have any significant difference （P〉0.05）. For the cancer focus, the relief differences of complete remission and partial remission were statistically significant between two groups （P〈0.01）, but the difference of the constituent ratio of T staging change was not statistically significant （P〉0.05）. Conclusion The value of neo-adjuvant chemotherapy should not be limited to decrease the stage of cancer, and it is important to pay more attention to the high quality of combined therapy. Further research should be carried out to find the contribution of neo-adjuvant chemotherapy to mini-invasive surgery.

关 键 词：多学科协作 新辅助化疗 结直肠癌 手术方案 

分 类 号：R735.3[医药卫生—肿瘤]