全直肠系膜切除加局部及全身化疗在直肠癌治疗中的应用  

The role of regional perfusion and systemic chemotherapy with total mesorectum excision in treatment of rectal cancer

作　　者：何建苗[1] 王羽[1] 崔科英[1] 徐石岩[1] 吴有军[1] 蒲永东[1] 

机构地区：[1]解放军第三0九医院普通外科,北京100091

出　　处：《中国普通外科杂志》2010年第4期335-338,共4页China Journal of General Surgery

摘　　要：目的探讨全直肠系膜切除(TME)加髂内动脉局部灌注及全身化疗在直肠癌治疗中的作用。方法将193例直肠癌患者随机分为两组:观察组98例,在TME术后应用髂内动脉置泵化疗及全身化疗;对照组95例,在TME术后行全身化疗。观察并比较两组的术后局部复发率、远处转移率和生存率。结果术后1,3,5年局部复发率,观察组分别为0%(0/98),2.5%(2/81),3.8%(3/79);对照组分别为1.1%(1/95),11.4%(9/79),16.2%(11/68)。术后1,3,5年远处转移率:观察组分别为1.1%(1/98),6.2%(5/81),12.7%(10/79);对照组分别为2.1%(2/95),24.1%(19/79),30.9%(21/68)。两组1年生存率均为100%,3年生存率观察组为79.0%(64/81),对照组为57.0%(45/79);5年生存率观察组为73.4%(58/79),对照组为52.9%(36/68)。除1年局部复发率、远处转移率及生存率外,两组3,5年术后局部复发率及3,5年远处转移率和术后3,5年生存率各相应时间段比较,差异均有统计学意义(P<0.05)。结论TME加髂内动脉灌注化疗及全身化疗可显著降低直肠癌患者局部复发率及远处转移率,提高患者生存率,是治疗直肠癌的有效模式。Objective To evaluate the role of regional chemotherapy via internal iliac artery pump, systemic chemotherapy and total mesorectum excision （TME） in the treatment of rectal cancer. Methods A total of 193 patients with rectal carcinoma divided into 2 groups： The observation group, included 98 cases who underwent TME, regional chemotherapy through internal iliac artery pump and systemic chemotherapy. The other 95 cases, as control group, were treated with systemic chemotherapy after TME. The local recurrence rate, metastasis rate and survival rate were compared between the two groups. Results The local recurrence rate and metastasis rate of the observation group was significantly lower than that of the control group. The local recurrence rate at 1 - , 3 - and 5 - year was significantly lower in the observation group [ 0,2.5 % （ 2/ 81） and 3.8% （3/79） respectivvely]than that in the control group [1. 1% （1/95） ,11.4% （9/79） and 16.2% （11/68） respectively] （P〈0.05）. The 1 - , 3 - , and 5 -year distant metastasis rate in the observation group was 1% （ 1/98 ） , 6.2 % （ 5/81 ） and 12.7 % （ 10/79 ） respectively, while that in the control group was 2. 1% （ 2/95 ） , 24. 1% （ 19/79 ） , 30. 9% （ 21/68 ） respectively, which showed significant differences between the two groups （ P 〈 0. 05 ）. The 3 - and 5 - year survival rate of the observation group （ 79. 0 % , 73. 4 % respectively ） was higher than that of the control group （ 57. 0 % , 52.9% respectively ） （ P 〈 0. 05 ）. Conclusions Regional perfusion via internal iliac artery pump and systemic chemotherapy with TME has proved to be a safe and effective treatment that could reduce local recurrence rate and distance metastasis rate, and is an effective method to improve the survival rate of rectal cancer patients.

关 键 词：直肠肿瘤 全直肠系膜切除 灌注化疗 髂内动脉 

分 类 号：R735.37[医药卫生—肿瘤]