术前不同途径新辅助化疗联合腹腔镜手术治疗直肠癌近远期效果临床研究  

Short-term and long-term effects of preoperative neoadjuvant chemotherapy combined with laparoscopic surgery for rectal cancer by different routes

作　　者：王德康 鲁信军 李浩 WANG Dekang;LU Xinjun;LI Hao(Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,China)

机构地区：[1]安康市中医医院,陕西安康725000

出　　处：《陕西医学杂志》2022年第10期1240-1243,共4页Shaanxi Medical Journal

基　　金：陕西省安康市科技计划项目(2018AK03-08)。

摘　　要：目的:探究动脉介入和静脉滴注两种新辅助化疗联合腹腔镜手术治疗直肠癌的近远期效果,以期为提高患者治疗效果提供参考。方法:随机硬币投掷法将收集的80例Ⅱ-Ⅲ期直肠癌患者分为两组。患者均接受相同方式腹腔镜手术切除和术后化疗,同时静脉组术前选用静脉滴注方式进行新辅助化疗,动脉组选择动脉介入灌注方式进行新辅助化疗,比较两组手术切除效果和随访结果。结果:两组手术时间、术中出血量、淋巴结清扫数目、术后首次排气时间比较差异无统计学意义(均P>0.05)。动脉组肿瘤病灶切除总体效果明显优于静脉组,尤其病灶理想切除率显著高于静脉组(P<0.05),术前和治疗后的血清CEA、CA242、CA19-9水平显著低于静脉组(均P<0.05)。动脉组随访3年的无瘤生存率(88.10%)、总生存率(78.57%)与静脉组(71.05%、65.79%)比较差异无统计学意义(均P>0.05),但随访3年的无瘤生存期和总生存期明显长于静脉组(P<0.05)。结论:全身静脉式辅助化疗相比,直肠癌腹腔镜手术治疗前给予动脉介入式新辅助化疗能有效抑制相关肿瘤标志物表达,提高病灶手术切除效率,延长术后复发转移时间和生存时间。Objective:To explore the short-term and long-term effects of neoadjuvant chemotherapy combined with laparoscopic surgery in the treatment of rectal cancer by arterial intervention and intravenous infusion,in order to provide reference for improving the therapeutic effect of patients.Methods:A total of 80 patients with stage Ⅱ-Ⅲ rectal cancer were divided into two groups by random coin tossing method.All patients were treated by laparoscopic surgical resection and postoperative chemotherapy.At the same time,the intravenous infusion method was used for neoadjuvant chemotherapy before operation in the intravenous group,and the arterial perfusion method was used for neoadjuvant chemotherapy in the arterial group.The surgical resection effect and follow-up results were compared between the two groups.Results:There was no significant difference in operation time,intraoperative blood loss,number of lymph node dissections,and time to first exhaust after operation between the two groups(all P>0.05).The overall effect of tumor lesion resection in the arterial group was significantly better than that in the venous group,especially the ideal tumor resection rate was significantly higher than that in the venous group,but the levels of serum CEA,CA242 and CA19-9 before and after treatment were significantly lower than those in the venous group(all P<0.05).There was no significant difference in the tumor-free survival rate and overall survival rate between the arterial group and the venous group(88.10% vs.71.05% and 78.57% vs.65.79%) during the 3-year follow-up(all P>0.05).The tumor-free survival and overall survival in the arterial group were significantly longer than those in the venous group(all P<0.05).Conclusion:Compared with systemic intravenous adjuvant chemotherapy,arterial interventional neoadjuvant chemotherapy before laparoscopic surgery for rectal cancer can effectively inhibit the expression of related tumor markers,improve the efficiency of surgical resection of lesions,prolong postoperative recurrence and met

关 键 词：直肠癌 腹腔镜手术 辅助化疗 动脉介入 静脉滴注 

分 类 号：R735.3[医药卫生—肿瘤]