全系膜切除、侧韧带全切除并术中动脉灌注化疗治疗直肠癌

Treatment of rectal cancer with total mesorectal excision,total lateral ligaments excision combined with intraoperative superior rectal artery infusion chemotherapy

目的探讨直肠全系膜切除、侧韧带全切除加术中直肠上动脉灌注化疗治疗直肠癌的效果。方法对我科的112例直肠癌患者采用直肠全系膜切除(total mesorectal excision,TME)、直肠侧韧带全切除(total lateral ligaments excision,TLLE)加术中直肠上动脉灌注化疗(intraoperative superior rectal artery infusion chemotherapy,ISRAIC)。结果腹会阴切除(abdominalperineal resection,APR)术式42例,术后会阴部切口感染4例(9.5%);经腹前切除术式(anterior resection,AR)70例,无吻合口瘘发生。112例中腹部切口感染5例(4.4%),无严重的术后并发症及手术死亡发生。术后随访36-62个月,盆腔局部复发3例(2.7%),肝转移8例(7.1%)。生存5年以上者79例(70.5%)。结论直肠全系膜切除、侧韧带全切除加术中直肠上动脉灌注化疗治疗直肠癌,术后局部复发、肝转移低,该手术操作可望成为提高直肠癌手术治疗效果的重要方法。

Objective To investigate the efficacy of total mesorectal excision（TME）,total lateral ligaments excision（TLLE） combined with intraoperative superior rectal artery infusion chemotherapy（ISARIC） in treatment of rectal cancer.Methods A total of 112 patients diagnosed with rectal cancer were treated by total mesorectal excision,total lateral ligaments excision combined with intraoperative superior rectal artery infusion chemotherapy.Results Of 112 patients,42 patients underwent abdominal perineal resection（APR）,of whom,4（6.5%） had post-operative perineal incision infection;and the other 70 patients received anterior resection,who had no leakage of anastomosis after the surgery.Post-operative abdominal incision infection happened in 5 cases（4.4%）,and no severe postoperative complications or mortality happened.All patients were followed up routinely for 36-62 months.The pelvic local cancer recurrence occurred in 3 cases（2.7%）,liver metastasis occurred in 8 cases（7.1%）,and 79 cases（70.5%）survived for more than 5 years after the surgery.Conclusion This new combined method for rectal carcinoma has lower rates of both local pelvic cancer recurrence and liver metastasis than that of TME only.Therefore,TME,TLLE combined with ISRAIC would be a promising standard procedure to improve the effects of mild-low rectal cancer treatment.