全直肠系膜切除和局部灌注化疗在直肠癌患者中的应用

Regional perfusion of chemotherapeatic drug combined with total mesorectum excision in the treatment of rectal cancer

目的探讨全直肠系膜切除加髂内动脉局部灌注化疗在直肠癌患者中的应用价值。方法回顾性分析1999-2006年收治的178例直肠癌患者在全直肠系膜切除基础上采用不同方法进行化疗的效果,其中观察组90例,在全直肠系膜切除后行髂内动脉置泵,术后行局部灌注化疗;对照组88例,在全直肠系膜切除术后行全身静脉化疗。观察并比较两组术后1、3、5年的局部复发率、远处转移率及生存率。两组患者的各项临床指标无明显差异,具有可比性。结果术后1、3、5年局部复发率,观察组分别为0%(0/90)、2.5%(2/79)、3.9%(3/77),对照组分别为1.1%(1/88)、3.9%(3/77)、8.1%(6/74),两组间差异均有统计学意义(P<0.05)。术后1、3、5年远处转移率,观察组分别为1.1%(1/90)、5.1%(4/79)、10.4%(8/77),对照组分别为2.3%(2/88)、7.8%(6/77)、17.6%(13/74),两组间差异均有统计学意义(P<0.05)。两组1年生存率均为100%。3年生存率观察组为70.9%(56/79),对照组为53.2%(41/77)。5年生存率观察组为65.0%(50/77),对照组为40.5%(30/74),差异均有统计学意义(P<0.05)。结论髂内动脉灌注化疗加全直肠系膜切除可显著降低直肠癌患者局部复发率及远处转移率,提高生存率。

Objective To evaluate the efficacy of regional perfusion of chemotherapeutic drug in rectal cancer patients who had undergone total mesorectum excision （TME）. Methods The therapeutic effects were retrospectively analyzed of 178 rectal carcinoma patients, who were admitted in the hospital from 1999 to 2006, had undergone TME, and then received chemotherapy through various routes. Among them, a catheter was placed in the left internal iliac vein, and chemotherapeutic drug was administered through it postoperatively in 90 patients. The other 88 cases served as control, and they received systemic intra-venous chemotherapy after TME. No significant difference on clinical parameters was evident between the two groups during the course of treatment. The 1, 3 and 5 year local recurrence rates, metastasis rates and survival rates of the two groups were compared. Results The 1, 3 and 5 year local recurrence rates in the study group were 0, 2. 5% （2/79） and 3. 9% （3/77）, respectively, while they were 1.1% （1/88）, 3. 9% （3/77） and 8. 1% （6/ 74）, respectively in control group. There was a significant difference in the local recurrence rate between two groups （P〈0. 05）. The 1, 3 and 5 year distant metastasis rates in study group were 1.1% （1/90）, 5. 1% （4/79） and 10. 4% （8/77）, respectively, and they were 2. 3% （2/88）, 7. 8% （6/77） and 17. 6% （13/74）, respectively in control group, and there was a significant difference between two groups （P〈0. 05）. The 1 year survival rates of the two groups were both 100%. The 3 and 5 year survival rates of the study group （70. 9%, 65. 0%, respectively） were higher than that of the control group （53. 2%, 40. 5% respectively, P〈0. 05）. Conclusions Iliac artery pump placement for perfusion chemotherapy is proved to be a safe and effective treatment in rectal carcinoma patients, and it may reduce local recurrence and distant metastasis of cancer, thus improves the survival rate of rectal cancer patients.