新辅助化疗联合甘露醇灌肠对局部晚期直肠癌治疗效果的影响

The effect of neoadjuvant chemotherapy combined with mannitol enema on treatment for locally advanced rectal cancer

目的分析新辅助化疗联合甘露醇术前灌肠对局部晚期直肠癌手术效果及术后恢复效果上的特点,为直肠癌的精准化治疗提供一定的参考依据。方法选取2012年1月到2017年1月期间收治的患有局部晚期直肠癌的老年患者为研究对象,讲所有患者随机分为单纯手术组(单纯行直肠癌根治术)、新辅助化疗组(术前进行3周期新辅助化疗后再行直肠癌根治术)、甘露醇灌肠组(术前1周行甘露醇灌肠后再行直肠癌根治术)和联合治疗组(术前3周期新辅助化疗并1周甘露醇灌肠后再行直肠癌根治术),比较四组患者在流行病学资料、疾病相关资料及手术资料上的差异性,并分析出影响直肠癌患者生存时间的因素。结果共有155例患者纳入本研究,其中单纯手术组和甘露醇灌肠组患者均为40例,新辅助化疗组37例,联合治疗组38例。四组患者在性别、年龄、体质量指数和吸烟史上差异无统计学意义(P>0.05)。联合治疗组患者的手术时长(F=5.075,P=0.002)和术后住院天数(F=19.108,P<0.001)均要明显小于其余各组,并且该组患者具有更长的生存时间。不同组患者在手术切除效果(χ^2=21.432,P<0.001)和术后肿瘤复发情况上(χ^2=12.485,P=0.006)存在明显差异,但在术后并发症上差异无统计学意义(χ^2=3.899,P=0.273)。尽管CA199及肿瘤T分期在各组间存在差异,但仅有组别是影响患者生存时间的主要因素(P=0.002)。结论新辅助化疗联合甘露醇灌肠治疗局部晚期直肠癌患者,可以在不增加术后并发症发生率的基础上,减少手术时长及保证手术R0切除,并且可以有效延长患者生存时间。

Objective To analyze the characteristics of neoadjuvant chemotherapy combined with mannitol enema on the surgical effects and postoperative recovery in the patients with locally advanced rectal cancer,and provide basis for accurate treatment on locally advanced rectal cancer.Methods Senile patients with locally advanced rectal cancer in First Affiliated Hospital of Hebei North University from January 2012 to January 2017 were enrolled in this study.Patients were divided into four groups:Simple Surgery Group,in which the patients received only radical resection of rectal cancer;Neoadjuvant Chemotherapy Group,in which the patients should receive three cycles of neoadjuvant chemotherapy before having surgery;Mannitol Enema Group,in which the patients should receive one week of mannitol enema before surgery;Combined Treatment Group,in which the patients should receive three cycles of neoadjuvant chemotherapy and one week of mannitol enema before surgery.Epidemiological data,diseases data and surgical data were compared among different groups.The influencing factors of survival time were explored by Cox regression in patients with locally advanced rectal cancer.Results 155 patients were enrolled in this study.The Simple Surgery Group and Mannitol Enema Group both had 40 patients.The Neoadjuvant Chemotherapy Group had 37 patients and the Combined Treatment Group had 38 patients.There were no significant differences of sex,age,BMI and smoke among four groups.The surgical duration(F=5.075,P=0.002)and postoperative hospitalization days(F=19.108,P<0.001)in the combined treatment group were much shorter than that in other three groups.Besides,there were differences of surgical resection effect(χ^2=21.432,P<0.001)and postoperative tumor recurrence(χ^2=12.485,P=0.006)among four groups.Four groups had significant differences in postoperative complications(χ^2=3.899,P=0.273).Although CA199 and T stage showed differences among four groups,groups was the sole influencing factor on survival time(P=0.002).Conclusions Neoadjuvant chemotherapy combined with mannitol enema cannot increase the incidence of postoperative complica?tions.At the meantime,it can reduce the surgical duration and ensure surgical R0 resection.It can also prolong the survival time in the patients with locally advanced rectal cancer.