冷冻疗法治疗低位直肠癌

Clinical observation of cryotherapy in the treatment of low rectal cancer

目的探讨超低温冷冻消融保肛术对于低位直肠癌治疗的临床治疗效果。方法采用超低温冷冻消融保肛术治疗低位直肠癌的患者36例,在治疗后3个月和治疗后6个月,对其主要症状、肿瘤标志物的变化、存活率、复发率、转移率、生命质量评分、肛门直肠功能评分等方面分别进行观察和记录。结果治疗后6个月患者梗阻症状、黏液血便、排便习惯改变、里急后重及腹胀腹痛症状均有所改善(P<0.05);治疗后6个月患者外周血癌胚抗原显著降低(P<0.05);治疗后3个月、治疗后6个月患者的肛门功能与治疗前的比较差异具有统计学意义(P<0.05);生命质量方面,与治疗前比较,患者治疗6个月后躯体形象、未来期望、胃肠症状、排便问题明显改善(P<0.05)。治疗后6个月随访发现生存率为100%,有2例出现复发,没有1例发生新的转移灶。结论超低温冷冻消融保肛术治疗低位直肠癌具备“消瘤、减瘤、抑瘤”的三大特点,能使人体原有的消化道直肠肛门保持通畅,避免了既往腹会阴联合切除造成的直肠肛门被切除、腹壁造瘘、排便方式改变的痛苦。

Objective To investigate the clinical effect of cryoablation for anal preservation in the treatment of low rectal cancer.Methods The main symptoms,changes of tumor markers,survival rate,recurrence rate,metastasis rate,quality of life scores and anorectal function scores were observed and recorded in patients with low rectal cancer treated by cryoablation over 3 and 6 months after treatment.Results The symptoms of obstruction,mucosanguineous feces,change of defecation habits,tenesmus and abdominal distension and pain were all improved 6 months after treatment(all P<0.05).Six months after treatment,the carcinoembryonic antigen level in peripheral blood of patients was significantly decreased(P<0.05).The anal function of patients was significantly different 3 months and 6 months after treatment from that before treatment(P<0.05).In terms of quality of life,6 months after treatment,the body image,future expectation,gastrointestinal symptoms and defecation problems of patients were all significantly improved compared with those before treatment(P<0.05).Six months after treatment,a follow-up revealed that the survival rate was 100%,with two cases of recurrence yet no new metastases.Conclusion Cryoablation for anal preservation in the treatment of low rectal cancer features"eliminating tumor,reducing tumor and suppressing tumor",which can keep the original digestive tract,rectum and anus unobstructed,avoiding the pain of rectum and anus excision,abdominal wallfistula and change of defecation mode caused by combined abdominal and perineal excision in the previous practice.