直肠癌术后盆内骶前手术间隙灌注式化疗疗效探讨

Efficiency of Postoperative Chemotherapy for Rectal Carcinoma Patients through Pelvic Pre-Sacral Space Irrigation

目的:探索预防直肠癌术后盆内局部复发的新途径。方法:对我院43例直肠癌切除术后病人采用盆内骶前手术间隙灌注式化疗新方法,术中盆内骶前手术间隙置管,术后连续3天经该管生理盐水冲洗,术后7天灌注5-氟尿嘧啶进行盆内手术间隙化疗。结果:43例无手术死亡。术后随访6～65月,局部复发4例(9.3%),肝转移6例(13.9%),腹膜后淋巴转移3例(6.9%),生存5年31例,5年生存率为75.5%。治疗引起的不良反应及术后并发症包括:白细胞减少1例,恶心呕吐2例,腹部伤口感染1例、会阴伤口感染2例,拖出肠段坏死1例。无吻合口瘘、盆内大出血、盆内感染等严重局部并发症。结论:本法操作简单,应用方便,具有高选择性区域化疗特点,全身不良反应小,无严重局部并发症,局部复发率低,5年生存率较高,具有较好的预防局部复发效果,可望成为直肠癌切除术后防治局部复发的辅助化疗新途径。

Objective: To investigate the local recurrence of rectal carcinoma after operation. Methods: A new chemotherapy method through pelvic pre-sacral space irrigation was attempted on 43 patients who received resection of rectal carcinoma in the authors′ hospital. A tube was placed in the pelvic pre-sacral space during operation. The space was washed with 1000 ml of saline for 3 days after operation through the tube. The pelvic pre-sacral space irrigation with 1.0 g of 5-Fluorouracil was administered for 7 days after operation. Results: No operative mortality occurred. All the patients were followed up routinely, with local recurrence in 4 cases (9.3%), liver metastasis in 6 cases (13.9%), retroperitoneal lymphatic metastasis in 3 cases (6.9%). Thirty-one patients existed for 5 years. The 5-year survival rate is 75.5%. The side effects and postoperative complications included: leukocytopenia in 1 case on the seventh day after operation, anorexia and vomiting in 2 cases on the fifth to seventh day after operation, infection of abdominal wound in 1 case and infection of perineal wound in 2 cases on the third day after operation, necrosis of output colon in 1 case on the tenth day after operation. Those serious complications, such as leakage of anastomosis, massive bleeding or infection in the pelvic cavity, were not occurred. No severe side effects occurred. Conclusion: This new method is very convenient to practice and is a kind of highly selective regional chemotherapy with few general side effects and without severe regional complications. Low local recurrence and high 5-year survival rate were gained in this group. Postoperative chemotherapy through pelvic pre-sacral space irrigation can effectively prevent local recurrence. It might become a new hopeful method to prevent postoperative local recurrence of rectal carcinoma.