低分子肝素在直肠癌新辅助治疗中的应用价值研究

Study on short-term effects and side effects of low molecular weight heparin combined with neoadjuvant therapy on locally advanced rectal cancers

目的观察低分子肝素联合新辅助放化疗治疗局部晚期直肠癌的近期疗效及不良反应。方法选取2014年3月—2016年6月青岛市中心医院收治的58例局部晚期直肠癌患者,随机分为两组,治疗组(同步放化疗+低分子肝素)和对照组(单纯同步放化疗),放疗采用外照射,DT45Gy/25F,同步化疗采用口服卡培他滨850 mg/m2,每天两次,治疗组低分子肝素皮下注射4 100 IU IH(放化疗前3天~放化疗后1周),观察两组凝血指标、不良反应,放化疗结束后8周手术进行疗效评价。结果治疗组RR率86.7%,对照组82.1%,但差别无统计学意义(P>0.05);对照组有2例发生下肢深静脉血栓,抗凝组没有发现,主要不良反应为I°~II°胃肠道反应、I°~II°手足综合征、II°~III°骨髓抑制,两组间不良反应比较无统计学意义(P>0.05)。结论局部晚期直肠癌新辅助放化疗并用低分子肝素是安全可行的,可提高同步放化疗疗效,并减少下肢深静脉血栓的发生率。

Objective To obeserve the short-term effects and side-effects of low molecular weight heparin combined withneoadjuvant therapy on locally advanced rectal cancers. Methods Totally 58 patients with locally advanced rectal cancer were divided into two groups randomly. The treatment group（ concurrent radiochemotherapy combined with low molecular weight heparin） and control group（ simply concurrent radiochemotherapy）. Radiotherpy was external irradiation,DT45 Gy/25 F,combined with xeloda（ 850 mg/m2 bid po） concurrently,and with low molecular weight heparin subcutaneous injection 4100 IU IH qd（ from three days before radiochemotherapy to one week after radiochemotherapy）.Obeserved their coagulation indicators and side-effects in two groups respectively. Surgeries were had 8 weeks later than radiochemotherapy to appraise the effects. Results The RR ratio in treatment group is 86. 7%,the control group is82. 1%. The difference has not statistic magnificance. There were two patients companied by thrombus of lower extremity veins in control group,but not in treatment group. The main side-effects were gastrointestinal reactions in I°-II° levels,hand-foot syndromes in I°-II° levels,myelosuppression in II°-III° levels. There was not statistic magnificance between two groups too. Conclusion Low molecular weight heparin combined with neoadjuvant therapy on locally advancedrectal cancers is safe and practical. Low molecular weight heparin can improve the effects of radiochemotherapy and reduce the occurrence of thrombus of lower extremity veins.