Ⅰ^(125)粒子近距离放疗联合腹腔镜手术治疗直肠癌的疗效观察  

The clinical effect of Ⅰ^(125) seed implantation during laparoscopic operation for the treatment of rectal cancer

作　　者：吕国庆[1] 李冠[1] 何立锐[1] 裴大兵[1] 李亮[1] 刘铮[1] 白植军[1] 

机构地区：[1]北京大学深圳医院,广东深圳518036

出　　处：《腹腔镜外科杂志》2012年第12期907-909,共3页Journal of Laparoscopic Surgery

基　　金：深圳市科技计划项目(编号:200602053)

摘　　要：目的:探讨腹腔镜直肠癌手术中植入Ⅰ125粒子近距离放疗辅助治疗直肠癌的效果。方法:选择2007年1月至2011年6月行腹腔镜直肠前切除术的45例患者,随机分为两组,并进行前瞻性对照研究,A组(n=22)术中于肿瘤浸润或可能复发转移部位植入Ⅰ125粒子,常规化疗6个周期,B组(n=23)术后以45～50Gy外放射治疗5周后常规化疗6个周期。两组化疗方案相同(FOLFOX方案)。术后随访12～54个月,对比两组患者并发症、肛门控便功能、局部复发率及远处转移率。结果:两组患者术后吻合口漏发生率、局部复发率及远处转移率差异无统计学意义;A组放射性肠炎、放射性膀胱炎及皮肤放射性损伤等放疗并发症发生率明显低于B组(P<0.05),肛门控便功能、吻合口狭窄率A组明显低于B组(P<0.05)。结论:腹腔镜直肠癌术中植入Ⅰ125粒子近距离放疗可明显降低因外放疗引起的放射性肠炎、放射性膀胱炎、控便功能异常等并发症,有效预防直肠癌的复发,并显著提高患者的生活质量。Objective ： To investigate the effect of Ⅰ^125 seed implantation during laparoscopic operation for the treatment of rectal cancer. Methods：From Jan. 2007 to Jun. 2011 45 patients received radical laparoscopic anterior resection were randomly divided into two groups , Group A （ n = 22 ） ： During the laparoscopic surgery, I ,25 were implanted to the tumor bed or to the place with the possibility of recurrence or metastasis and the upper and lower of the stoma, then 6 cycles of chemotherapy followed ; Group B （ n = 23 ） ： After the laparoscopic surgery, the patients routinely received external radiotherapy （45-50Gy）for 5 weeks, then 6 cycles of chemotherapy followed. The chemotherapy regimen （FOLFOX） was same in two groups. During the follow-up of 12-54 months ,the incidence of com- plications,local recurrence and far distance metastasis were analyzed. Results： There were no significant difference in the rate of anastomotic leakage,local recurrence and rate of distant metastasis between two groups. Compared with Group B, the function of bowel control and rate of stoma constriction were lower （ P 〈 0.05 ）. The incidence of radiation enteritis, radiation cystitis and skin radiation injury in Group A were significantly lower than Group B （ P 〈 0.05 ）. Conclusions ： Laparoscopic rectal surgery combined with Ⅰ^125 seed implantation can significantly reduce the complications of external radiotherapy, effectively prevent the recurrence of rectal carcinoma and significantly improve the quality of life.

关 键 词：直肠肿瘤 腹腔镜检查 Ⅰ125粒子 近距离放疗 

分 类 号：R735.37[医药卫生—肿瘤]