多学科协作诊治模式下结直肠癌术后新辅助化疗相关不良反应的临床研究  

Neo-Adjuvant Chemotherapy Related to Adverse Reaction after Colorectal Cancer Operation in Multi-Disciplinary Team

作　　者：汪晓东[1] 曹霖[1] 曾天芳[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7期529-532,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨多学科协作(multi-disciplinary team,MDT)诊治模式下结直肠癌术后新辅助化疗相关的不良反应。方法回顾性分析2007年11月至2008年1月期间四川大学华西医院肛肠外科专业组收治确诊为结直肠癌患者的临床资料,比较分析MDT组与非MDT组术后恢复指标以及术后1周、1个月时的化疗监测指标和不良反应。结果该期间本专业组共收治了确诊为结直肠癌的患者181例,有131例满足纳入条件,其中男95例,女36例;结肠癌20例,直肠癌111例。MDT组和非MDT组之间基线一致,2组间手术方式差异无统计学意义(P>0.05)。在术后康复过程中,MDT组患者拔除胃管的时间和拔除血浆引流管的时间明显早于非MDT组(P<0.01),同时MDT组经口进食的时间也早于非MDT组(P<0.05)。术后1周时,MDT组的白细胞(WBC)和CEA水平下降均多于非MDT组(P<0.05);且此时食欲不振、神经炎/神经反射消失以及脱发的现象在MDT组内所占比例大于非MDT组(P<0.05)。术后1个月时,2组间WBC的差异无统计学意义(P>0.05),而MDT组CEA值的下降大于非MDT组,差异有统计学意义(P<0.05);此时MDT组内脱发现象的构成比仍大于非MDT组,差异有统计学意义(P<0.05)。结论本研究中MDT组在手术治疗的同时联合应用了术后快速康复流程,从而获得了更好的康复效果,但新辅助化疗有可能带来术后近期康复阶段更多的不良反应,这可能成为影响该类患者术后恢复的风险,如何合理安排术后以及出院后的康复策略,使这一风险得到规避,并同时保证近期的恶性肿瘤综合治疗效果,需要进一步的研究。Objective To explore the postoperative adverse reaction related to the neo-adjuvant chemotherapy after colorectal cancer operation in the multi-disciplinary team （MDT）. Methods The data of patients diagnosed definitely as colorectal cancer in West China Hospital of Sichuan University between November 2007 and January 2008 was retrospectively analyzed. Between MDT group and non-MDT group, the postoperative rehabilitative index, the index related to the neo-adjuvant chemotherapy and adverse reaction on postoperative week 1 and month 1 were compared. Results During this period, totally 181 patients were definitely diagnosed as colorectal cancer, and 131 patients were included according to the including criteria. Among the patients included, there were 95 males and 36 females, 20 colonic cancers and 111 rectal cancers. The baseline between MDT group and non-MDT group was equal, and the difference of the operative type existed between two groups was not statistically significant （P〉0.05）. In the process of postoperative rehabilitation, the gastric tube and drainage tube were moved out more earlier in MDT group than those in non-MDT group （P〈0.01）, and MDT group had an earlier oral feeding （P〈0.05）. On postoperative week 1, WBC decreased markedly in MDT group than that in non-MDT group （P〈0.05）, however, the discrepancy of CEA showed statistically significant （P〈0.05） ; and in MDT group there were more patients suffered inappetence, neuritis or neurological deficits or alopecia （P〈0.05）. On postoperative month 1, the difference of WBC between two groups was not statistically significant （P〉0.05）, whereas the value of CEA diminished more in MDTgroup than that in non MDT group （P〈0.05）; and in MDT group there were more alopecia still （P〈 0.05）. Conclusion In this study, the patients in MDT group treated by surgery combined with postoperative fast track got a better rehabilitation. But the neo-adjuvant chemotherapy may cause more adverse reaction at early stage of

关 键 词：多学科协作 结直肠癌 新辅助化疗 不良反应 

分 类 号：R735.34[医药卫生—肿瘤]