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醫(yī)學免費論文:術前放化療對低位直腸癌保肛手術作用的臨床研究
【摘要】 目的 探討術前放化療對中晚期低位直腸癌保肛手術的作用價值。方法 43例低位中晚期直腸癌患者，術前予3野或4野盆腔照射，總劑量45 Gy/5周，每周5次，每次1.8 Gy，并于放療第1、3周同步四氫葉酸鈣200 mg/m2,靜脈輸注d1～d5，氟脲嘧啶500 mg/m2，靜脈輸注12 h d1～d5化療，完成放化療后，4～6周手術，術后2～4周，追加2～4周期化療。結果 治療前T3 20例，T4 23例。放化療后，CR 6例，PR 19例，NC 18例，降期25例，降期率58.1%;3例腫瘤完全消失，未手術。40例行直腸癌根治性手術，其中29例為保肛手術，11例為經腹會陰直腸手術，保肛率為74.4%(32/43)，包括3例未手術者。術后隨訪13～59個月，中位隨訪時間34個月，隨訪無局部復發(fā)，1例伴有肝轉移，無死亡，總復發(fā)率為2.33%(1/43)，無瘤生存率97.67%(42/43)。結論 低位直腸癌術前放化療能縮小腫瘤，降期，提高腫瘤的切除率和保肛成功率，降低局部復發(fā)，延長生存時間。
【關鍵詞】 直腸腫瘤;化學療法;放射療法;手術
Clinical effect of preoperative radiotherapy and chemotherapy on sphincter
preserving surgery in advanced low rectal cancer醫(yī).學全.在.線網站quanxiangyun.cn
YAN Gang1, YE Tao2, YAO Zeming1, SHEN Wenbin2
(1. Department of Tumor Surgery, Xuzhou Tumor Hospital, Xuzhou, Jiangsu 221005, China;
2. Department of Radiotherapy, Xuzhou Tumor Hospital)
Abstract： Objective To investigate the value of preoperative radiotherapy and chemotherapy in sphincter preserving surgery in advanced low rectal cancer. Methods 43 patients with advanced low rectal cancer underwent preoperative 3 or 4 pelvic field irradiation, at the dosage of 45 Gy/5 weeks, 5 times a week, with 1.8 Gy each. They were given simultaneously calcium folinate 200 mg/m2 (intravenous dripping 1-5 days) and fluorouracil 500 mg/m2 (intravenous dripping 12 hours, 1-5 days) in the 1st and 3rd weeks of radiotherapy. Subsequent to radiotherapy and chemotherapy, surgery was performed from the 4th to 6th week. Additional 2-4 cycles of chemotherapy were appended 2-4 weeks after operation. Results Of the 20 cases of T3 stage and 23 cases of T4 stage undergoing radiotherapy and chemotherapy, there were 6 cases of complete remission (CR), 19 cases of partial remission (PR), 18 cases of no change (NC), 25 cases of down-staging at a proportion of 58.1%, and 3 cases of complete tumor disappearance without operation. Of the 40 cases of radical surgery of rectal cancer, 29 cases underwent sphincter preserving surgery and 11 cases had abdominal-perineal rectal surgery, at a sphincter-saving rate of 74.4% (32/43), including 3 cases without surgery. Post-operative follow-up of 13-59 months, with the median follow-up time of 34 months revealed that there was no local recurrence, 1 case had hepatic metastasis and there was no death, the total recurrence rate being 2.33% (1/43) and disease-free survival rate being 97.67% (42/43). Conclusion Preoperative radiotherapy and chemotherapy in advanced low rectal cancer surgery can reduce the size of tumor, decrease tumor staging, increase excision rate of tumor and success rate of sphincter preserving, depress local recurrence and extend survival time.
Key word:rectal tumor; chemotherapy; radiotherapy; operation
