直肠癌围手术期治疗在器官功能保护中的价值与挑战  

Pros and cons of perioperative therapy in the protection of organ function in rectal cancer

作　　者：曹键[1] 申占龙[1] 叶颖江[1] Cao Jian;Shen Zhanlong;Ye Yingjiang(Gastrointestinal Surgery,Beijing University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科,100044

出　　处：《中华胃肠外科杂志》2021年第4期291-296,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81871962)。

摘　　要：直肠癌患者的治疗目标是在保证手术根治性的基础上,更好地保护器官功能,从而提高患者生活质量。围手术期放化疗在降低患者局部复发率和提高远期生存率方面,已获得充分的循证医学证据;但从器官功能保护的角度来看,围手术期放化疗对患者的器官功能保护利弊共存。一方面,术前放化疗后肿瘤明显降期、降级或临床完全缓解的患者,若选择局部切除或严密随访的等待观察治疗策略,则能最大程度保全器官功能;而另一方面,放化疗的不良反应可加重排粪、排尿及性功能障碍。术前准确判断是否病理完全缓解,是选择治疗方式的关键。需要清醒意识到,保留器官不等同于保护器官功能。对于需要进行围手术期放化疗的患者,应根据患者的病情优化治疗手段。术前进行充分器官功能评估,选择合适的治疗策略;术中注意重要组织器官和神经的保护,提高手术质量;术后积极随访并尽早开展器官功能锻炼,以减少功能障碍的发生和对患者生活质量的影响。The goal of rectal cancer treatment should be to better protect organ function and improve patients'quality of life on the basis of ensuring radical resection.The current evidence has proved the superiority of perioperative chemoradiotherapy in reducing local recurrence and improving long-term survival.From the perspective of organ function protection,however,perioperative chemoradiotherapy has both disadvantages and advantages.Despite the great help in improving long-term outcomes,adverse reactions of chemoradiotherapy can aggravate defecation,urination and sexual dysfunction.Also,for patients with significant or complete remission,if the treatment strategy of local resection or close follow-up is selected,organ function can be preserved to the greatest extent.The key to the choice of treatment is to evaluate preoperatively whether pathological complete response is achieved.It should be kept in mind that preserving organ itself is not the same as protecting organ function.For patients who need perioperative chemoradiation,the optimal treatment methods should be chosen based on the patient's condition.Surgeons should fully evaluate organ function before operation,select the appropriate treatment strategy,pay special attention to the protection of important organs and nerves during surgeries,and carry out close postoperative follow-up and organ function rehabilitation as soon as possible,so as to reduce the incidence of dysfunction and the impact on the quality of life.

关 键 词：直肠肿瘤 围手术期放化疗 器官功能保护 

分 类 号：R735.37[医药卫生—肿瘤]