改良新辅助放化疗加术中温热灌洗治疗低位直肠癌的临床应用

Clinical Application of Modified Neoadjuvant Radiochemotherapy Combined with Intraperitoneal Hyperthermic Perfusion Chemotherapy for Lower Rectal Cancer

【目的】评估低位直肠癌手术前行改良新辅助放化疗+术中温热灌洗治疗的近期疗效及肿瘤的病理学改变,探索治疗低位直肠癌的新途径。【方法】45例低位直肠癌患者DukesB期(17)、DukesC期(28)随机分为:A组15例行自行设计改良的新辅助治疗:术前放疗、区域动脉介入微泵灌注化疗,按时辰多通道程控输液泵给药;B组15例,术前放疗+区域动脉介入一次性灌注化疗;C组15例诊断明确后手术;45例患者均行术中腹腔温热灌洗化疗。【结果】A、B、C组在术前降低肿瘤临床分期、提高保肛率和复发率方面相比较有显著性差异(P<0.05),A、B、C组肿瘤的病理改变相比较差异有统计学意义(P<0.05)。【结论】改良新辅助放化疗+术中腹腔温热灌洗化疗治疗低位直肠癌具有较好的临床疗效,能提高保肛率和生存率。

【Objectives】 To evaluate the clinical efficacy and pathological changes after modified preoperative neoadjuvant radioche-motherapy combined with intraperitoneal hyperthermic perfusion chemotherapy for lower rectal cancer. 【Methods】 Forty-five patients with lower rectal cancer （Dukes B,Dukes C） were divided into three groups. Group A employed preoperative modified neoadjuvant radio chemotherapy,chronomodulated micros-pump infusions chemotherapy of combined L-OHP with 5-FU and CF by the way of regional intra-arterial procedure; Group B employed preoperative radiotherapy and regional intra-arterial chemotherapy （PRAC）; While group C surgery alone. All cases accepted intraperitoneal hyperthermic perfusion chemotherapy in the procedure of operation. The short term efficacy and pathological changes were evaluated in these cases. 【Results】 The higher percentages of keeping anus,the lower percentages of recurrence and obviously pathological changes occurred in group A. There were significant difference among group A,B,and C （P 0.05）. 【Conclusions】 Modified preoperative neoadjuvant therapy was better than that of regional intra-Arterial chemotherapy clinical efficacy or surgery alone in the efficacy of treatment of lower advanced rectal cancer.