MDT诊疗模式在进展期直肠癌患者综合治疗中的应用效果观察  

Effect of multidisciplinary team in comprehensive treatment of advanced rectal cancer

作　　者：石蕊 杜易芳[1] Shi Rui;Du yifang(Department of Minimally Invasive Biliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China)

机构地区：[1]哈尔滨医科大学附属第一医院微创胆道外科,黑龙江哈尔滨150001

出　　处：《结直肠肛门外科》2019年第1期57-61,共5页Journal of Colorectal & Anal Surgery

基　　金：黑龙江省普通医学科研项目(201603019)

摘　　要：目的探讨多学科团队协作诊疗(MDT)在进展期直肠癌患者综合治疗中的应用效果。方法纳入2014年2月至2015年2月本院收治的80例进展期直肠癌患者作为研究对象,采用随机数字表法将患者分为观察组和对照组,每组各40例。观察组采用MDT诊疗模式,对照组行常规诊疗模式。比较两组患者手术相关情况、治疗效果、术后并发症发生率,随访观察术后3年生存情况。结果两组手术时间、术中出血量及术中淋巴结清扫数目比较差异均无统计学意义(均P> 0.05)。观察组术后首次肛门排气时间和术后住院时间短于对照组,差异均有统计学意义(均P <0.05)。两组术后并发症总发生率比较差异无统计学意义(P> 0.05)。治疗后观察组pCR率为15%,对照组pCR率为2.5%,两组比较差异有统计学意义(P <0.05)。新辅助治疗后两组临床分期比较差异有统计学意义(P <0.05)。观察组术后3年失访1例,肿瘤进展10例,其中死亡9例;对照组术后失访2例,肿瘤进展16例,其中死亡11例,两组术后3年总生存率和肿瘤无进展生存率比较差异均无统计学意义(Log-rank χ~2=0.383、1.880,P=0.536、0.170)。结论 MDT用于指导进展期直肠癌的综合治疗有助于提高肿瘤控制率,促进术后早期康复,但尚未观察到对患者预后改善的促进作用。Objectives To investigate the effect of multidisciplinary team (MDT) in comprehensive treatment of advanced rectal cancer. Methods 80 patients with advanced rectal cancer treated in our hospital between February 2014 and February 2015 were recruited and randomly assigned to treatment group and control group, with 40 patients in each group. Patient in the treatment group received MDT treatment model and those in the control group received routine treatment. Indices related to operation, effectiveness, incidence of postoperative complications, and 3-year survival after follow-up of three years were compared between the two groups. Results There was no significant difference in duration of surgery, amount of intraoperative blood loss, and the number of dissected lymph nodes between the two groups (P > 0.05). Time to postoperative anal exhaust and duration of postoperative hospitalization were significantly shorter in treatment group than in control group (P < 0.05). There was no significant difference in overall incidence of complications between the two groups (P > 0.05). pCR was 15% and 2.5% in treatment group and control group, respectively, with significant difference between the two groups (P < 0.05). There was also significant difference between the two groups in clinical stage after the neoadjuvant treatment (P < 0.05). In the treatment group, 1 patient was lost-to-follow-up, 10 had progression and 9 had died. The corresponding figures in the control group were 2, 16, and 11, respectively. There was no significant difference in overall 3-year survival (Log-rank χ2 = 0.383, P = 0.536) and progression-free survival (Log-rank χ2 = 1.880, P = 0.170) between the two groups. Conclusion As guidance for comprehensive treatment for advanced rectal cancer, MDT could increase control of the tumor, promote early postoperative recovery, but it had no effect on improving patients’prognosis.

关 键 词：进展期直肠癌 多学科团队 临床疗效 生存情况 综合治疗 

分 类 号：R735.3[医药卫生—肿瘤]