直肠癌短程放疗后根治性前切除的手术安全性及疗效分析

Safety and efficacy of preoperative short-term radiotherapy in radical anterior resection of rectal carcinoma

目的术前短程放疗可有效降低盆腔局部复发率,文中探讨术前短程放疗对于直肠癌根治性前切除术手术安全性的影响及远期疗效。方法 2006年7月至2009年12月收治的直肠癌患者分为先行短程放疗后手术的短程组(41例)和直接行根治性前切除的对照组(78例),观察记录和对比2组术中出血量、手术时间、术中意外损伤发生率、术后排气时间、住院时间、并发症发生率以及局部反复率和生存率等。结果短程组放疗后早期毒副作用轻,术中出血量为(221.0±154.6)ml,手术时间为(171.7±54.2)min,术后排气时间为(68.5±47.6)h,术后住院时间为(13.1±10.2)d,术中意外和术后并发症的发生率为分别2.4%和22.0%。与对照组比较均无统计学差异(P>0.05)。术后局部复发率短程组仅9.8%,与对照组的38.5%比较差异显著(P<0.01);术后3年生存率也显著改善,分别为56.1%和34.6%(P<0.05)。结论直肠癌短程放疗后行根治性前切除安全可靠,术后局部复发率显著降低,生存率得到改善。

Objective Short-term preoperative radiotherapy （STPR） can effectively reduce postoperative local recurrence of rectal carcinoma. This study was to investigate the safety and efficacy of STPR in radical anterior resection （RAR） of rectal carcinoma. Methods Totally, 119 patients with rectal carcinoma were assigned to receive STPR before RAR （ STPR group, n = 41 ） and directly RAR of the tumor （ control group, n = 78）. We compared between the two groups the rates of intra- and post-operative complications, loeal recurrence, and survival. Results In the STPR group, early toxicity was acceptable, and the intra-operative blood loss, oper- ating time, time to first postoperative flatus and hospital stay were （221.0± 154.6） ml, （171.7 ±54.2） min, （68.5 ±47.6） h and （ 13.1 ± 10.2） d, and the incidence rates of intra- and post-operative complications were 2.4% and 22.0%, with no significant differ- ences from those in the control group （P 〉 0.05）. The rate of local recurrence was significantly lower and that of 3-year survival re- markably higher in the former than in the latter （ 9.8% vs 38.5 %, P 〈 0.01 ; 56.1% vs 34.6%, P 〈 0.05 ）. Conclusion For RAR of rectal carcinoma, STPR is safe, and can lower postoperative local recurrence and improve 3-year survival.