直肠癌TME术后低渗5-FU液盆腔持续温热灌洗的疗效研究

Clinical Study on Hypotonic 5-FU Sustatined Pelvic Lavage on Patients with Stage III Rectal Cancer undergoing TME Surgery

目的:探讨Ⅲ期直肠癌患者TME术后低渗5-FU液盆腔持续温热灌洗的临床价值。方法:灌洗组40例Ⅲ期直肠癌患者TME术后第1天开始进行盆腔持续温热灌洗化疗,连续3d。对照组40例术后不进行盆腔灌洗,仅常规引流。对两组患者手术后并发症及术后局部复发和生存情况进行比较。结果:(1)手术并发症两组间无显著性差异。(2)灌洗组:第1天灌洗液离心后6例检及肿瘤细胞,13例中可见细小组织碎片,其中2例组织病理切片可见肿瘤细胞浸润,l例为淋巴结转移,其余组织为血凝块;第2、3天灌洗液未检出异常。对照组40例第l、2、3天引流液离心后未检出肿瘤细胞,未见组织碎片。(3)灌洗组和对照组1年生存率和复发率比较无显著性差异(P>0.05),3、5年生存率两组比较有显著性差异(P<0.05),两组3、5年复发率有显著差异(P<0.05)。结论:低渗5-FU液盆腔持续温热灌洗可以降低Ⅲ期直肠癌患者术后复发率,提高生存率,尤其对直肠系膜周边阳性、直肠系膜切除不完整者更有重要意义。该方法操作简便,无不良反应。

Objective：To evaluate the clinical value of hypotonic 5-FU sustained pelvic lavage On patients with stage Ⅲrectal cancer undergoing TME surgery. Methods：40 patients with stage Ⅲrectal cancer undergoing TME surgery were chosen to start sustaine pelvic thermotherapy lavage chemotherapy on the first day, and repeated for three consecutive days.Other 40 cases in the control group were only given conventional drainage. The post-operative complications, postoperative local recurrence and survival rate of the two groups were compared. Results： （1）There were no significant difference in surgical complication between two groups.（2）In the treatment group, the tumor ceils had been detected in lavage fluid which followed by centrifugation in 6 eases on the first day, and small tumor debris had been deteetedin other 13 cases, of which 2 cases＇s pathological slices could found tumor cells,and 1 case have lymph node metastasis, others were of the hemagglutiuin block. But on the second and third days no abnormal fluid had been detected. In the control group,no tumor cells and debris had been found in any patient in three days.（3）There were no significant differences in survival rate and recurrence rate in the first year between two groups（P 〉0.05）,but the differences were obvious in 3,5-years（P 〈0.05）.Conclusion：Hypotonic 5-FU sustained pelvic lavage technique can reduce the recurrence rate and improve survival rates of stage HI cancer,particularly, it was important for the patients whose surrounding mesorecturn is positive or the surgical resection is incomplete.The method is simple,but no adverse reactions.