腹腔镜联合新辅助放化疗在中低位直肠癌中的应用

Application of laparoscopic surgery following neoadjuvant chemoradiotherapy for mid-low rectal cancer

目的探讨腹腔镜联合新辅助放化疗(CRT)在中低位直肠癌治疗中应用的安全性和可行性。方法回顾性分析南方医科大学附属南方医院普外科2007年1月至2008年5月间行腹腔镜手术+CRT的24例中低位直肠癌病例(新辅助组)。另随机抽取同期收治的行腹腔镜手术的直肠癌病例24例(对照组)。对两组临床资料和手术学资料进行比较分析。结果新辅助组淋巴清扫数目[(7.08±6.5)枚]低于对照组[(12.5±4.1)枚],两组之间存在显著性差异(P<0.05);两组在手术时间、术中出血、肛门排气时间、远端切缘阳性、中转开腹、术后并发症发生等方面无显著性差异。结论腹腔镜联合CRT在中低位直肠癌应用中安全、可行。

Objective To evaluate the safety and feasibility of laparoscopic surgery following neoadjuvant chemoradiotherapy （CRT） for mid-low rectal cancer. Methods A retrospective analysis was conducted among 24 patients with mid-low rectal cancer who received laparoscopic total mesorectal excision （TME） after neoadjuvant CRT. Another 24 patients with mid-low rectal cancer were randomly selected form those undergoing primary laparoscopic TME to serve as the control group. The clinical data and surgical data of the two groups of patients were collected and analyzed comparatively. Results TME after CRT resulted in significantly lower lymph node yield compared with the control group （7.08±6.5 vs 12.5±4.1, P〈0.05）. The two groups were comparable in the operative time, intraoperative blood loss, intestinal function recovery, positive surgical margins, rate of conversion to open surgery, and occurrence of intra- and postoperative complications. Conclusion Laparoscopic surgery of mid-low rectal cancer after neoadjuvant CRT can be safe and feasible and produce surgical effects comparable to exclusive laparoscopic surgery.