直肠癌新辅助治疗联合保肛手术34例分析  

Neoadjuvant Chemoradiotherapy Combined with Sphincter-Preserving Surgery in Treatment of 34 Patients with Rectal Cancer

作　　者：薛小军[1,2] 陈少全[1,2] 涂小煌[1,2] 宋京翔[1,2] 

机构地区：[1]福建医科大学福总临床医学院 [2]南京军区福州总医院普通外科,福州350025

出　　处：《中国普外基础与临床杂志》2010年第8期824-827,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨新辅助放化疗联合保肛手术治疗局部进展期直肠癌的安全性。方法回顾性分析2007年6月至2009年6月期间我科收治的34例T3、T4期低位直肠癌采用新辅助放化疗联合保肛手术治疗患者的临床资料。常规分割放疗,总剂量40Gy,每周5次,每次2Gy。于第4周放疗结束后开始行全身化疗,1个疗程,方案为奥沙利铂(150mg/d1)、亚叶酸钙(100mg/d1～3)加5-FU(750mg/d1～3)。于新辅助治疗结束后4周进行手术。结果经新辅助治疗后,肿瘤直径平均缩小41.2%,67.6%(23/34)的病例T分期下降,淋巴结阴转率为58.8%(10/17)。术后无吻合口漏发生,发生肝转移1例,局部复发1例;88.2%(30/34)患者术后肛门功能良好。结论对局部进展期直肠癌患者采用新辅助放化疗,能使肿瘤分期降低;联合行保肛手术,不增加手术并发症的发生率,安全、有效。Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer. Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy,five times a week,2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）,plus folinic （100 mg/d1-3） and 5-FU （750 mg/d1-3） for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy. Results After neoadjuvant therapy,all patients underwent surgical resection with average tumor size decreased by 41.2%,tumor T stage decreased in 67.6% （23/34） patients,and lymph node-negative change rate was 58.8% （10/17）. One patient had liver metastasis and one had local recurrence,but without stomal leak. And 88.2% （30/34） patients showed good function of sphincter. Conclusion s Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging,which is safe without increasing operation complications when combined with sphincter-preserving surgery.

关 键 词：新辅助放化疗 低位直肠癌 保肛手术 敏感性 

分 类 号：R735.37[医药卫生—肿瘤]