TME联合~125Ⅰ粒子植入治疗中下段直肠癌

The value of total mesorectal excision with ~125I seed implantation in middle-lower portion of rectal cancer

目的探讨全直肠系膜切除(TME)联合^(125)Ⅰ粒子术中植入治疗进展期中下段直肠癌的效果。方法 67例中下段直肠癌 TME 手术根治患者(均为 Dukes’B、C 期),分成3组:①组:TME手术根治加化疗组24例;②组:TME 手术根治加放疗组18例;③组:TME 手术根治联合^(125)Ⅰ粒子植入组19例。跟踪随访2年内复发率;同时比较②与③组并发症的发生情况。结果 3组1.5年内复发率分别为46%、11%和5%;②、③组复发率低于①组(X^2=4.291、6.771,P<0.05),③组复发率与②组相比差异无显著性;但③组并发症的发生率(10%)比②组(44%)明显降低(确切概率计算法,P=0.029)。结论 TME 联合^(125)Ⅰ粒子术中植入有助于预防直肠癌术后复发,且并发症的发生率低。

Objective To study the effect of total mesorectal excision （TME） with ^125I seed implantation in progressive middle-lower portion rectal cancer. Methods Sixty-seven middle-lower portion rectal cancer cases （ all were Ducks B, C stage ） were treated with three different methods. ①TME with chemotherapy in 24 cases （ group 1 ）. ②TME with radiotherapy in 18 cases （ group 2 ）. ③TME followed by ^125I seed implantation in 19 cases （group 3）. All cases had been followed up for two years. Recurrence rate in three groups and complications in groups 2 and group 3 were observed. Results The recurrence rates in three groups in 1. 5 years were 46% , 11% , 5% respectively, The recurrence rates in group 2 and group 3 were lower than that in group 1 （ P 〈 0.05 ）, but there was no significant difference between group 2 and group 3. The incidence of complications in group 3 was lower than that in group 2 （ P = 0. 029 ）, Conclusion TME with ^125I seed implication can reduce the recurrence rate of progressive rectal cancer and also lower its incidence of complications.