局部中晚期直肠癌手术联合内外放射治疗随机对照研究

A Randomized Control Study on Combination of Surgery with Internal and External Radiation Therapy for 56 Patients with a Locally Advanced Rectal Carcinoma

为探讨术中预埋置管内放射对局部中晚期直肠癌局部控制率作用，本文分析５６ 例局部中晚期直肠癌采用手术加术后外放射（外放射组２１ 例） 或手术加术中预埋置管内放射（内放射１９ 例） 或手术加内、外放射治疗（ 内、外放射组１６ 例） 随机对照研究结果，全组随访最长４８ 个月，最短３２ 个月。结果表明：术中预埋置管成功率９２－２ ％ ，管次治疗成功率９８－５ ％ ，盆腔局部控制率三组分别为７６－２ ％ 、７９ ％ 和８７－５ ％ ，内外放射组略高于其他两组；同样４ 年生存率内外放射组６７ ％ 略高于外放射（６２ ％ ） 和内放射组（５９ ％ ），内外放射组早期治疗相关并发症（５６－２ ％ ）主要与内放射“袖套区”剂量控制不当有关。我们认为术中预埋置管内放射方法简便可靠且不受解剖部位限制，可作分次放射，与外放射配合可提高局部中晚期直肠癌术后局部控制率，进一步调整内放射分次剂量，确切估计高危区，控制“袖套区”剂量以及术中带血管肌皮瓣重建等可进一步降低治疗并发症和改善局部控制率。

It was analized that a randomized control study for 56 patients with a locally advanced rectal carcinoma treated by a combination of surgery with external irradiation (21 cases) or intraoperative brachytherapy(19 cases) or both (16 cases).A result was demonstrated that a successful rate of putting brachytherapy Vecton tubes during operation and of irradiation for each tube were 92 2% and 98 5% respectively.The group treated by combination of the internal with external irradiation had shown a superior local control rate (87 5%) as compared with the external irradiation (76 2%) and the internal irradiation (79%),also for 4-year survival rate(67%,62% and 59% respectively). A higher complication rate for patients with internal and external irradiation was associated with a poor control to dose of “Mandchon zone” of brachytherapy. We consider that an intraoperative brachytherapy is of a charactor of easy practice,higher reliability and less demand for anatomical constraint and promising fractionated irradiation.A combination of brachytherapy and external irradiation therapy to improve the postoperative local control rate is useful for patients with locally advanced rectal carcinoma.