肠造口术在局部进展期直肠癌综合治疗中的作用

Effects of enterostomy in treating locally advanced rectal cancer with combined chemoradiotherapy and operation

目的分析和探讨肠造口术在局部进展期直肠癌患者综合治疗中的作用。方法分析51例行术前放化疗和手术治疗的直肠癌患者的临床资料,对直肠癌综合治疗中肠造口术的选择和肠造口并发症进行分析。结果术前放化疗后64.9%的患者 T 期下降,病理完全缓解率21.6%,37例直肠癌患者接受了肠造口手术,其中腹膜外乙状结肠造口术29例,回肠袢式造口术8例,3例患者因术前放化疗过程中出现肠梗阻症状而先期接受了远、近端结肠分别造口术以暂时转流粪便,全组术后出现造口旁疝和造口狭窄各1例,造口旁感染2例,无造口相关手术死亡。结论在直肠癌综合治疗过程中,结肠造口术可减低梗阻肠段压力,解除肠道梗阻,确保综合治疗的顺利完成;而回肠造口术可促进综合治疗后保肛手术中远端结直肠吻合口的愈合,减少吻合口漏带来的风险。

Objective To investigate the effect of enterostomy in treatment of locally advanced retal carcinoma patients with combined chemoradiotherapy and operation. Methods Clinical data from 51 cases of locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and operation were analyzed. Results Thirty-three patients （64.9%） got downstage of their cancer after preoperative chemoradiotherapy, and 21.6% of patients（ 11 cases） had complete pathologic response. Thirty-seven patients received enterostomy, including extraperitoneal sigmoidestomy （29 cases）, defunctioning ileostomy （8 cases） and double colestomy （3 cases with colon obstruction during preoperative therapy）. One case experienced parstomal hernia and one stomal stenosis and 2 cases parstomal infection after enterostomy. No death of enterostomy occurred. Conclusion Culestomy can reduce the pressure of obstructed intestinal tract and contribute much to the preoperative chemoradiotherapy, ileestomy can protect the distal stoma from leakage in sphincter saving operation. Enterostomy could be selected when needed in the favor of locally advanced rectal cancer patients.