新辅助治疗对低位直肠癌患者经腹会阴联合直肠切除术后会阴切口愈合的影响

Impact of neoadjuvant chemoradiation on perineal wound healing after abdominoperineal resection for lower rectal cancer

目的探讨新辅助治疗对于低位直肠癌经腹会阴联合直肠切除术（APR）后会阴切口愈合的影响。方法回顾性分析北京协和医院基本外科2005年1月至2009年1月实施APR术的93例直肠癌患者的临床资料．其中29例行术前新辅助治疗（新辅助治疗组）．64例直接手术（直接手术组）。将会阴伤口愈合情况分为甲、乙、丙级。对比观察两组患者会阴切口愈合情况。结果新辅助治疗组29例术前行局部放疗（50Gv，25次／5周）并同步联合化疗，采用FOLFOX4方案（氟尿嘧啶、奥沙利铂）；APR术后会阴伤口甲级愈合18例（62．1％），乙级愈合6例（20．7％），丙级愈合5例（17．2％）：直接手术组会阴伤口甲级愈合41例（64．1％），乙级愈合15例（23．4％），丙级愈合8例（12．5％）；两组间伤口感染（丙级愈合）发生率差异无统计学意义（P=0．773）。结论术前新辅助治疗尤其是50Gv的长程放疗不增加APR术后会阴伤口的感染发生率。

Objective To evaluate the impact of neoadjuvant chemoradiation on perineal wound healing following abdominoperineal resection （APR） for lower rectal cancer. Methods Data of 93 patients who underwent APR for low rectal cancer between January 2005 and January 2009 in Peking Union Medical College Hospital were reviewed, including patients who received neoadjuvant chemoradiation （n=29） and those undergoing surgery alone （n=64）. Perineal wound healing was the primary outcome measurement. Condition of wound healing was classified as good, moderate, and poor and was compared between the two groups. Results Twenty nine patients in the neoadjuvant group received preoperative regional radiation （50 Gy, 25 fractions/5 weeks） with synchronous FOLFOX4 chemotherapy（fluouracil and oxalipatin）. In the neoadjuvant group, wound healing after APR was good in 18 patients （62.1%）, moderate in 6 （20.7%）, and poor in 5 （17.2%）. In patients who had surgery alone, wound healing after APR was good in 41 patients （64.1%）, moderate in 15 （23.4%）, and poor in 8 （12.5%）. There was no significant difference in the incidence of wound infection （poor wound healing）between the two groups （P=0.773）. Conclusion Neoadjuvant chemoradiation therapy is not associated with increased perineal wound infection following abdominoperineal resection for low rectal cancer.