多学科协作诊治模式下新辅助/辅助化疗联合结直肠癌手术的临床效果  

Clinical Effect of Neo-Adjuvant Chemotherapy and Adjuvant Chemotherapy Combined with Operation on Colorectal Cancer Patients 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科,成都610041

出　　处：《中国普外基础与临床杂志》2008年第8期615-619,共5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,结直肠癌手术围手术期不同新辅助/辅助化疗治疗策略的临床效果。方法回顾性分析2007年1-12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,将患者分为非辅助化疗组（新辅助化疗＋手术治疗）和辅助化疗组（新辅助化疗＋手术治疗＋辅助化疗）,比较2组的治疗效果。结果共收治了789例结直肠疾病患者,其中明确诊断为结直肠癌并符合纳入研究条件的患者195例,其中男109例,女86例;年龄为25-84岁,中位年龄60.00岁,平均59.98岁;结肠癌59例,直肠癌136例。随访时间为5-17个月,全部195例患者中失访3例,成功随访率为98.5%,随访期间无复发和死亡。2组患者基线基本一致,2组间术前内科合并症、肿瘤并发梗阻症状和术前是否输血的差异无统计学意义（P〉0.05）;2组在术中是否输血和Dukes分期方面的差异有统计学意义（P〈0.05）,而其他手术相关指标和病理指标间差异无统计学意义（P〉0.05）;在术后治疗中,2组间是否输血的差异有统计学意义（P〈0.05）;术后住院期间康复指标在2组间差异无统计学意义（P〉0.05）;2组间术后并发症和排便情况差异无统计学意义（P〉0.05）。术后1和3个月随访中发现,2组间CEA和CA19-9值差异有统计学意义（P〈0.05）。结论在MDT诊治模式下,进行新辅助化疗＋手术治疗＋辅助化疗方案并不影响患者的康复,也不增加患者术后并发症的风险,并可能提高患者术后对排便习惯的接受程度,具有一定的安全性和临床价值,但是否能提高临床效果有待进一步研究。Objective To explore the clinical effect of neo adjuvant/adjuvant chemotherapy combined with operation on colorectal cancer patients in the muhi-disciplinary team （MDT）. Methods The data were collected retro-spectively from January to December in 2007. The patients were classified as non-adjuvant chemotherapy group and adjuvant chemotherapy group according to the treatment strategy. Non adjuvant chemotherapy group had accepted only surgery followed by preoperative neo-adjuvant chemotherapy, and adjuvant chemotherapy group had taken postoperative adjuvant chemotherapy after preoperative neo-adjuvant chemotherapy and operation. The clinical effect of two groups were compared. Results Totally 789 patients were treated among 2007, and 195 patients who were firstly diagnosed as colorectal cancer were included, and there were 109 males and 86 females, 59 colonic cancers and 136 rectal cancers. Average age was 59. 98 years old. All of the included patients were followed up for 5 17 months. Three cases missed, no recurrence and no death happened. The baseline between non adjuvant chemotherapy and adjuvant chemotherapy group was nearly same. There were no differences between two groups about the in- ternal medicine complications, the cancer related obstruction, preoperative transfusion or not （P〉0.05）. Whether the patients were transfused or not during the procedure and Dukes stage were significantly different between two groups （P〈0.05）, while the other surgical and pathological index didn＇t show any statistical significance （P〉 0. 05）. After operation, more patients in non-adjuvant chemotherapy group had accepted transfusion （P〈0.05）. However, the postoperative rehabilitative indexes during hospitalization were not different between two groups. And the differences about the postoperative complications and defecation were not significant （P〉0.05）. The values of CEA and CA19-9 were greatly different between two groups in the 1st and 3rd month follow-up. Conclusion The strategy of neo-ad

关 键 词：多学科协作 结直肠癌 新辅助化疗 辅助化疗 

分 类 号：R735.34[医药卫生—肿瘤] R197.3[医药卫生—临床医学]