全直肠系膜切除术前不同放疗方案对直肠癌患者的影响

Effects of Different Radiotherapy Regimens before Total Mesorectal Resection on Patients with Rectal Cancer

目的:探讨全直肠系膜切除术前不同放疗方案对直肠癌患者的影响。方法:选择2015年4月—2018年4月于聊城市第五人民医院肿瘤外科住院治疗的直肠癌患者70例为研究对象,根据随机数字表法分为常规放化疗组和短程放疗组,各35例。两组均进行全直肠系膜切除术,常规放化疗组术前采用常规放化疗治疗,短程放疗组术前采用短程放疗。比较两组不良反应、手术情况、治疗依从性、疗效。结果:两组恶心呕吐、放射性肠炎、放射性皮炎、放射性膀胱炎、骨髓抑制发生率比较,差异无统计学意义(P>0.05)。两组术中出血量、手术时间及肺部感染、切口感染发生率比较,差异无统计学意义(P>0.05);短程放疗组腹泻、便秘、膀胱刺激征发生率低于常规放化疗组(P<0.05)。短程放疗组认识疾病、定期检查、坚持治疗、自我防护、饮食依从率高于常规放化疗组(P<0.05)。短程放疗组病理分期降级率低于常规放化疗组(P=0.011);两组病理完全缓解率、局部复发率及3年生存率比较,差异无统计学意义(P>0.05)。结论:全直肠系膜切除术前短程放疗与常规放化疗的安全性相当,但对晚期患者宜行常规放化疗,使分期降级后再行手术切除。短程放疗治疗时间短,患者依从性好,可结合患者实际情况综合考虑治疗方案。

Objective:To investigate the effect of different radiotherapy regimens before total mesorectal resection on rectal cancer patients.Methods:A total of seventy patients with rectal cancer who were hospitalized in the Department of Tumor Surgery of Liaocheng Fifth People's Hospital from April 2015 to April 2018 were selected as the study objects.According to random number table method,they were divided into conventional chemoradiotherapy group and short course radiotherapy group,with thirty-five cases in each group.Total mesorectal excision was performed in both groups.Conventional chemoradiotherapy group was treated with conventional chemoradiotherapy before surgery,while short course radiotherapy group was treated with short course radiotherapy before surgery.The adverse reactions,operation status,treatment compliance and curative effect of the two groups were compared.Results:There was no significant difference in the incidence of nausea and vomiting,radiation enteritis,radiation dermatitis,radiation cystitis and bone marrow suppression between the two groups(P>0.05).There was no significant difference in intraoperative blood loss,operation time and incidence of pulmonary infection and incision infection between the two groups(P>0.05);the incidence of diarrhea,constipation and bladder irritation in the short course radiotherapy group was lower than that in the conventional chemoradiotherapy group(P<0.05).The rates of disease recognition,regular examination,adherence to treatment,self-protection and diet compliance in short course radiotherapy group were higher than those in conventional chemoradiotherapy group(P<0.05).The pathological stage degradation rate of short course radiotherapy group was lower than that of conventional chemoradiotherapy group(P=0.011);there was no significant difference in pathological complete response rate,local recurrence rate and 3-year survival rate between the two groups(P>0.05).Conclusion:The safety of short course radiotherapy before total mesorectal resection is comparable to that of conventional chemoradiotherapy,but conventional chemoradiotherapy should be used for advanced patients to reduce the stage and then surgical resection.Short course radiotherapy treatment time is short,patient compliance is good,can be combined with the actual situation of patients to consider the treatment plan.