低位局部进展期直肠癌治疗中新辅助同步放化疗联合TME术价值探究.docVIP

低位局部进展期直肠癌治疗中新辅助同步放化疗联合TME术的价值探究 　　摘要：目的 全直肠系膜切除（total mesorectal excision，TME）是目前直肠癌手术治疗的标准方法，但由于其复杂的结构，局部病灶清除不完全致使切除率降低，术后复发风险高。本文探讨新辅助同步放化疗联合TME术治疗对中低位局部进展期直肠癌的有效性和安全性。方法 选取本院2011年6月～2013年12月收治的60例中低位局部进展期直肠癌患者，包括28例Ⅱ期（T3-4T0M0），32例Ⅲ期（T1-4N1-2M0）。所有患者均接受术前新辅助放化疗（放疗总剂量盆腔区为40～46Gy，瘤床区为50～56Gy，1.8Gy/次，5次/w，同步化疗采用FOLFOX4方案，行2个周期）。新辅助同步放化疗结束4～6w后根据TME原则行手术治疗。结果 60例患者均完成新辅助放化疗，放化疗期间1～2级不良反应发生率为70.0%，3级不良反应发生率为10.0%，无4级不良反应发生。患者临床TNM分期下降。新辅助放化疗结束后4～6w，60例患者行根治性手术治疗，其中38例行低位或超低位前切除术（Dixon术），22例行腹会阴联合切除术（Miles术），保肛率75.0%（45/60）。无1例发生围手术期死亡，术后并发生症的总发生率为13.3%（8/60）。结论 新辅助同步放化疗联合TME对治疗中低位局部进展期直肠癌有效并安全，其可以降低肿瘤分期、复发率，提高保肛率。 　　关键词：肠癌；新辅助疗法；同步放化疗；TME术 　　Abstract：Objective TME（total mesorectal excision，TME）is currently the standard method of surgical treatment for colorectal cancer，but because of its complex structure，resulting in partial debridement incomplete resection rate decreased，risk of recurrence is high.This research is to evaluate the efficacy and safety of neoadjuvant concurrent chemoradiotherapy in combination with total mesorectal excision（TME）in treatment of locally advanced middle and lower rectal cancer.Methods 60 patients with locally advanced middle and lower rectal cancer in this hospital since June 2011 to December 2013 were selected as the observation group in this study，and 28 patients of whom had stageⅡ（T3-4T0M0），32 patients had stageⅢ（T1-4N1-2M0）.All patients received neoadjuvant concurrent chemoradiotherapy（the dose of preoperative radiotherapy was 40-50 Gy，1.8Gy/time，5 times per week；concurrently combined with two cycles of capecitabine-based regimen）.The surgical operation was performed 4～6 weeks after concurrent chemoradiotherapy.Results 60 patients completed the neoadjuvant concurrent chemoradiotherapy.The total rate of level 1-2 adverse reaction was 70%，the total rate of level 3 adverse reaction was 10%，no 4 adverse reaction.After radiation and chemotherapy，48 cases（80%）of clinical TNM staging were declined.60 patients were given surgical operati