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目的分析术前放化疗结合全直肠系膜切除术(TME)治疗低位进展期直肠癌的疗效。方法回顾性分析笔者所在医院2009年1月至2011年12月期间行术前放化疗联合TME的31例低位进展期直肠癌患者的临床资料。放疗采用常规分割放疗,总剂量50 Gy/25 f;化疗采用mFOLFOX6或CapeOX方案。临床-病理对照记录疗效,并评价保肛患者的肛门功能。结果全部患者均接受TME手术治疗,手术并发症发生率为12.9%(4/31),死亡率为3.2%(1/31)。经术前放化疗,肿瘤直径平均缩小21.9%;48.4%(15/31)的患者出现T分期下降,阳性淋巴结患者比例由83.9%(26/31)降至38.7%(12/31),5例(16.1%)患者获得病理学完全缓解,总有效率达74.2%(23/31);Ⅲ～Ⅳ度不良反应发生率为6.5%(2/31),保肛患者肛门功能良好率达84.6%(22/26)。结论从本组有限的病例看,对低位进展期直肠癌采用术前放化疗结合TME手术能够达到部分肿瘤的病理学完全缓解,缩小原发肿瘤,降低局部淋巴结转移率,从而达到降低肿瘤分期、提高手术疗效的目的。
Objective To analyze the effect of preoperative chemoradiotherapy combined with total mesorectal excision (TME) in the treatment of low-grade advanced rectal cancer. Methods The clinical data of 31 patients with low-grade advanced rectal cancer who underwent preoperative chemoradiation combined with TME from January 2009 to December 2011 in our hospital were retrospectively analyzed. Radiotherapy using conventional radiotherapy, the total dose of 50 Gy / 25 f; chemotherapy with mFOLFOX6 or CapeOX program. Clinical - pathological control records the efficacy and evaluation anal anal function in patients with anal. Results All patients underwent TME surgery. The incidence of complications was 12.9% (4/31) and the mortality rate was 3.2% (1/31). Tumor diameter decreased by 21.9% on average after preoperative chemoradiotherapy; T stage decreased in 48.4% (15/31) patients, and the percentage of positive lymph nodes decreased from 83.9% (26/31) to 38.7% (12/31); 5 Patients (16.1%) achieved complete remission of pathology, with a total effective rate of 74.2% (23/31). The incidence of adverse reactions of Ⅲ ~ Ⅳ was 6.5% (2/31) % (22/26). Conclusion From this group of limited cases, preoperative chemoradiotherapy combined with TME surgery for low-grade advanced rectal cancer can achieve partial remission of pathological tumors, reduce the primary tumor and reduce the local lymph node metastasis rate, so as to reduce the tumor stage, Improve the efficacy of surgery purposes.