腹腔镜联合同步新辅助放化疗治疗中低位局部进展期直肠癌的疗效观察

Clinical observation of laparoscopy combined with neoadjuvant chemoradiotherapy for middle and low locally advanced rectal cancer

目的:探讨腹腔镜联合同步新辅助放化疗治疗中低位局部进展期直肠癌的临床疗效。方法:收集2012年1月至2015年2月84例中低位局部进展期直肠癌患者的临床资料,将患者依据随机数字表法分为观察组与对照组,每组42例。对照组行开腹直肠癌根治术,观察组行新辅助放化疗联合腹腔镜直肠癌根治术。两组均至少随访2年。比较两组术中情况、免疫功能及并发症情况。结果:观察组手术时间显著长于对照组,术中出血量、住院时间、进食时间及肠道功能恢复时间均少于对照组(P<0.05);两组淋巴结清扫数量差异无统计学意义(P>0.05)。术后1~7 d,两组患者CD3+、CD4+、CD8+均较术前呈现先降低后升高的趋势,观察组术后第1天CD4+、CD8+水平均高于对照组,术后第7天CD3+、CD8+水平均高于对照组(P<0.05)。观察组总并发症发生率、粘连性肠梗阻发生率低于对照组(P<0.05)。结论:为中低位局部进展期直肠癌患者行腹腔镜联合同步新辅助放化疗的疗效优于传统治疗,且利于患者免疫系统的恢复,并发症少,值得临床推广应用。

Objective： To investigate the clinical effect of laparoscopy combined with neoadjuvant chemoradiotherapy for middle and low locally advanced rectal cancer. Methods： A total of 84 patients with middle and low locally advanced rectal cancer from Jan.2012 to Feb. 2015 were selected as the objective of this study. The patients were divided into the observation group and the control group according to the random number table method,there were 42 cases in each group. The patients in the control group were treated with open radical resection of rectal cancer,the observation group was treated with neoadjuvant chemoradiotherapy and laparoscopic radical resection of rectal cancer. The 2 groups were followed up for at least 2 years. The intraoperative conditions,immune function and postoperative complications of the 2 groups were recorded and compared. Results： The operation time of the observation group was significantly longer than that of the control group,the amount of bleeding during operation,hospitalization time,feeding time and the recovery time of intestinal function were significantly less than those of the control group（ P〈0. 05）,there was no significant difference in the number of dissected lymph node between the two groups（ P 〉0. 05）. After 1 day to 7 days,the CD3＋,CD4＋and CD8＋of 2 groups were decreased first and then increased（ P〈0. 05）; On the first day after operation,the levels of CD4＋and CD8＋in the observation group were significantly higher than those in the control group,and the levels of CD3＋and CD8＋after 7 days of the operation were significantly higher than those of the control group（ P〈0. 05）. The incidence of total complications and adhesive intestinal obstruction in the observation group was significantly less than that in the control group（ P〈0. 05）. Conclusions： Laparoscopy combined with concurrent neoadjuvant chemoradiotherapy is superior to traditional treatment for locally advanced rectal cancer. It is beneficial for the recovery of immune system and has fewer complications,and is worthy of clinical application.