局部晚期中低位直肠癌患者术前同步放化疗64例疗效分析及其护理

Locally Advanced Low Rectal Cancer in Patients with Preoperative Radiotherapy and Chemotherapy in 64 Cases

目的：观察分析局部晚期中低位直肠癌患者术前同步放化疗效果，为临床提供参考。方法：选择2008年6月-2012年6月来本院接受治疗的64例局部晚期直肠癌患者，采用5-氟尿嘧啶联合甲酰四氢亚叶酸进行术前同步放化疗，观察疗效和毒副作用。结果：64例患者同步放化疗后5周均行盆腔螺旋CT或MRI，腹部超声检查，总有效率为71.88%；患者表现出的毒副反应主要有腹泻、放射性直肠炎、恶心、呕吐、皮肤黏膜反应、血红蛋白减少、白细胞减少、肝功能异常和神经毒性，患者大多数为Ⅰ~Ⅱ度反应；患者手术治疗，经腹会阴联合切除（Miles术）41例（占64.06%），低位前切除术（Dixon术）18例（28.13%），Hartman术5例（7.81%），全部患者手术顺利，无围手术期死亡，最终行保肛手术者21例，总保肛率32.81%；随访2年后，无病生存47例，生存率为73.44%。结论：术前同步放化疗后，效果明显，不良反应轻，耐受性好，提高手术保肛率，是一较为理想的治疗局部晚期中低位直肠癌患者的方案。

Objective：To observe and analyze the locally advanced lower rectal cancer patients in preoperative radiotherapy and chemotherapy effect,to provide the reference for clinical.Method：64 cases of patients with locally advanced rectal cancer in 2008 June to 2012 June in our hospital were treated by 5-fluorouracil,folinic acidbenzoyl four hydrogen preoperative chemoradiotherapy,to observed the curative effect and side effect.Result：64 cases of patients with radiotherapy and chemotherapy after 5 weeks underwent pelvic CT or MRI,abdominal ultrasonography,the total efficiency of 71.88%;mainly include diarrhea,radiation proctitis,nausea,vomiting,skin and mucosa reaction, decrease in hemoglobin,leukopenia,liver function abnormalities and neurotoxic adverse reaction of patients show,most of the patients with grade I degree to II degree reaction;operation treatment of patients,resection of abdominal perineal （Miles）in 41 cases（64.06%）,low anterior resection（Dixon）in 18 cases（28.13%）,5 cases of Hartman（7.81%）, all patients with a smooth operation,no peri operation period death,eventually rectal operationin 21 cases,the total rate of anal preservation32.81%;after 2 years follow-up,disease free survival of 47 cases,the survival rate was 73.44%. Conclusion：Preoperative chemoradiotherapy,obvious effect,less adverse reaction,good tolerance,improve the operation rate of anal preservation,is the treatment of locally advanced low rectal cancer patients with an ideal scheme in.