5-氟尿嘧啶对直肠癌术后骶前手术间隙灌注化疗的临床研究

Clinic study of postoperative chemotherapy on rectal carcinoma patients through pelvic pre-sacral space irrigation with 5-Fluorouracil

目的 探索预防直肠癌术后盆内局部复发的新途径。方法 对 12 6例直肠癌切除术后患者采用盆内骶前手术间隙灌注式化疗新方法 ,术中盆内骶前手术间隙置管 ,术后连续 3天经该管生理盐水冲洗 ,术后 7天灌注 5 氟尿嘧啶进行盆内手术间隙化疗。结果 12 6例无手术死亡。术后随访 5年 ,局部复发 11例 (8 7% ) ,肝转移 16例 (12 7% ) ,腹膜后淋巴转移 8例(6 3% ) ,5年生存率为 74 7%。治疗副作用及术后并发症包括 :白细胞减少 1例 ,恶心呕吐 5例 ,吻合口瘘 1例 ,腹部伤口感染2例、会阴伤口感染 3例 ,拖出肠段坏死 1例。无盆内大出血、盆内感染等严重局部并发症。结论 所用方法操作简单 ,应用方便 ,具有高选择性区域化疗特点 ,全身毒副作用小 ,无严重局部并发症 ,局部复发率低 ,5年生存率较高 ,具有较好的预防局部复发效果 。

OBJECTIVE To study the preventability of local recurrence of rectal carcinoma after operation.METHODS A new chemotherapy method through pelvic pre sacral space irrigation was attempted on 126 patients who received resection of rectal carcinoma in the authors' hospital.A tube was placed in the pelvic pre sacral space during operation.The space was washed with 1000 ml of saline for 3 days after operation through the tube.The pelvic pre sacral space was irrigated with 1.0 g of 5 Fluorouracil for 7 days after operation.RESULTS No operative mortality occurred. All the patients were followed up for 5 years routinely,with local recurrence in 11 cases(8.7%),liver metasasis in 16 cases(12.7%),retroperitoneal lymphatic metastasis in 8 cases(6.3%).The 5 year survival rate is 74.7%.The side effects and postoperative complications included:leukocytopenia in 1 case on the seventh day after operation,anorexia and vomiting in 5 cases,leakage of anastomosis in 1 case,infection of abdominal wound in 2 cases and infection of perineal wound in 3 cases,necrosis of output colon in 1 case.Those serious complications,such as massive bleeding or infection in the pelvic cavity did not occurred.No severe side effects occurred.CONCLUSION This new method is very convenient to practice and is a kind of highly selective regional chemotherapy with few general side effects and without severe regional complications.Low local recurrence and high 5 year survival rate were obtained in this group of patients.Postoperative chemotherapy through pelvic pre sacral space irrigation can effectively prevent local recurrence.It might become a new hopeful method to prevent postoperative local recurrence of rectal carcinoma.