新辅助放化疗+双吻合器法治疗局部进展期低位直肠癌的临床研究

Stapling technique for locally advanced low rectal cancer

目的:探讨新辅助放化疗结合TME双吻合器法治疗局部进展期低位直肠癌的临床疗效。方法:将65例T3、T4期低位直肠癌随机分为A、B二组,给予45Gy/5周,每周5次,每次1.8Gy放射治疗。A组32例在放疗同时给予卡培他滨2500mg(/㎡·d),分2次口服,服用14d,休息7d,连续服用3周期至手术,术后2～4周再续服2～3周期;B组33例于放疗第1、3周予四氢叶酸钙200mg/㎡,静滴d1～d5,氟尿嘧啶500mg/㎡静滴12hd1～d5化疗,完成放化疗后4～6周手术,术后2～4周,追加2～4周期化疗。手术均按TME原则进行。结果:全部病例均完成新辅助放化疗,治疗前T334例,T431例。放化疗后,CR18例,PR31例,NC16例,降期49例,降期率75.4%,5例肿瘤完全消失未手术,44例行保肛手术,16例行经腹会阴直肠切除术,全组保肛率为75.5%(49/65),包括5例未手术者。术后分期:T018例,T15例,T220例,T315例,T47例,随访13～60个月,中位38.5个月。随访无局部复发,2例出现远处转移,无死亡,总复发率3.08%(2/65),无瘤生存率96.92%(63/65)。结论:新辅助放化疗+TME双吻合器法治疗局部进展期低位直肠癌,能有效地缩小肿瘤,达到降期,提高肿瘤的切除率、保肛率,降低肿瘤局部复发,延长生存时间的目的。

Objective：To investigate clinical curative value of Neoadjuvant chemoradiotherapy combined with TME double stapling treatments in advanced low rectal cancer surgery. Methods：65 patients with T3, T4 low rectal cancer was randomly divided into A, B two groups, Radiation therapy was given 45Gy / 5 weeks, 5 times per week, each 1.8 Gy. A group of 32 cases was given Capeeitabine 2500mg/（m2.d）in radiotherapy, 2 times taken orally, rested 7d after taken 14d, taken 3 week consecutive 3 cycle to surgery, postoperative 2 - 4 weeks to renew take 2 -3 cyeles.B group of 33 eases supplied simultaneously 4-Hydrogen Leueovorin 200mg / m2 （intravenous infusion l-Sdays） and Fluorouracil 500mg/m^2 （intravenous infusion 12 hours, 1-5days chemotherapy） in radio-therapy 1 and 3 weeks, and operated after completing chemotherapy 4 to 6 weeks, additional 2 to 4 cycles chemotherapy after 2 to 4 weeks. Operation proceeded according to the principle of TME. Results： 34 cases of T3 stage and 31 cases of T4 stage were completed new adjuvant radiotherapy and chemotherapy, they was completed remission （CR） 18 cases, partial remission （PR） 31 eases, no change （NC） 16 eases, 49 eases of descending stage and up to 75.4%, 5 eases of the tumor completely disappeared without operating. 44 cases was sphincter preserving surgery and 16 eases was abdominal-perineal rectal surgery, sphincter-saving rate was 75.5% （49/ 65 ）, including 5 cases of non-surgery. PT stages： 18 cases of TO stage, 5 eases of T1 stage, 20 cases of T2 stage, 15 eases of T3 stage, 7 eases of T4 stage, Follow-up 13 to 60 months, median 38.5 months. Follow-up no recurrence, 2 patients had distant metastasis, no death, the total recurrence rate of 3.08% （2 / 65）, tumor-free survival rate was 96.92% （63/65）. Conclusion： Neoadjuvant ehemoradiotherapy and TME double stapling treatment of locally advanced low rectal cancer can effectively shrink the tumor, reduce time and improve tumor resection rate, sphincter preservation rate and reduce local recurrence, prolong survival time.