新辅助放化疗联合全直肠系膜切除术治疗局部进展期直肠癌的疗效及安全性分析

Efficacy and safety analysis of neoadjuvant chemoradiotherapy combined with total mesenterectomy for locally advanced rectal cancer

目的 分析新辅助放化疗联合全直肠系膜切除术治疗局部进展期直肠癌的疗效及安全性。方法 回顾性分析广西医科大学第四附属医院2017年6月至2020年6月收治并行全直肠系膜切除术的局部进展期直肠癌患者的临床资料,共100例,按是否行新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)分为nCRT组(50例)和非n CRT组(50例)。比较两组患者治疗后的临床指标、术后并发症及对比新辅助放化疗前后肿瘤TNM分期。结果 新辅助放化疗后肿瘤分期明显下降。nCRT组患者新辅助放化疗后的术中出血量、保护性造口率高于非nCRT组,手术时间、术后住院时间长于非nCRT组,淋巴结清扫数及保肛率低于非nCRT组,差异均有显著性(P<0.05)。nCRT组和非nCRT组治疗后总体并发症发生率比较,差异无显著性(P> 0.05)。结论新辅助放化疗联合全直肠系膜切除术治疗虽然增加直肠癌患者的保护性造口率、延长手术时间、增加手术出血,但可明显降低肿瘤分期。

Objective To analyze the efficacy and safety of neoadjuvant chemoradiotherapy combined with total mesenterectomy in the treatment of locally advanced rectal cancer. Method The clinical data of 100 patients with locally advanced rectal cancer who underwent total mesenterectomy in The Fourth Affiliated Hospital of Guangxi Medical University from June 2017 to June 2020 were retrospectively analyzed, and they were divided into nCRT group(n=50) and non nCRT group(n=50)according to whether they underwent neoadjuvant chemoradiotherapy(nCRT) or not. The clinical indicators, postoperative complications and tumor stage before and after neoadjuvant chemoradiotherapy were compared between the two groups. Result The tumor stage decreased significantly after neoadjuvant radiotherapy and chemotherapy. The amount of intraoperative bleeding, operation time,postoperative hospital stay and protective stoma rate in nCRT group were higher than those in non nCRT group, and the number of lymph node dissection and anus preservation rate were lower than those in non nCRT group(P < 0.05). There was no significant difference in the overall incidence of complications between nCRT group and non nCRT group(P > 0.05). Conclusion Neoadjuvant chemoradiotherapy combined with total mesenterectomy can increase the protective stoma rate, prolong the operative time and increase the operative bleeding in rectal cancer patients, but can significantly reduce the tumor stage.