局部中晚期直肠癌行新辅助放疗后的外科治疗策略  

Surgical treatment strategies for locally advanced rectal cancer after neoadjuvant radiation

作　　者：傅传刚[1] 高显华[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《中华胃肠外科杂志》2013年第6期513-517,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金青年科学基金项目（81201936）;国家自然科学基金面上项目（30973460,81272561）

摘　　要：直肠癌新辅助放疗后的外科治疗策略选择非常复杂，需慎重权衡并发症发生率、肛门功能、局部复发率和长期生存率之间的关系，选择是密切观察、行局部切除术，还是行根治性手术。原发肿瘤的放疗敏感性与肠系膜淋巴结的放疗敏感性之间存在着高度的一致性。可用于指导治疗决策。放疗疗效显著者建议先行局部切除术，然后根据病理结果决定后续治疗方案：疗效不佳者建议直接手术。根治性手术的远切缘距离应大于1cm；并建议在放疗前对肿瘤的边缘进行标记。For locally advanced rectal cancer ＇after neoadjuvant radiation, it is difficult to make a choice between close observation, local resection, and radical resection. The decision should be made after carefully weighing postoperative complications, anal function, local recurrence and long-term surival. There is a high consistency of the radiosensitivity between primary tumor and mesenteric lymph node, which may be used to guide the treatment decisions. If the primary tumor shrinks significantly after neoadjuvant radiation, local resection is recommended, and the next treatment plan should be made based on the pathological examination of resected specimen. Transabdominal radical resection is recommended tbr unfavorable tumors. Distal resection margin should be at least 1 cm, and marking the inferior margin of tumor is also recommended before neoadjuvant radiation since it would shrink significantly after radiation.

关 键 词：直肠肿瘤 新辅助放疗 外科手术 治疗策略 

分 类 号：R735.37[医药卫生—肿瘤]