术前放化疗对中低位直肠癌患者手术及术后并发症的影响

目的探讨术前放化疗对中低位直肠癌患者手术及术后并发症的影响。方法回顾性分析2009年1月至2010年12月间第二军医大学长海医院肛肠外科收治的174例T3～T4期中低位进展期直肠癌患者的临床资料,其中接受术前放化疗者加手术治疗者81例（放化疗组）,直接行手术治疗者93例（对照组）。结果术前放化疗组和对照组患者的手术切除率分别为100％（81／81）和94．6％（88／93）,差异无统计学意义（P〉O．05）;保肛率分别为86.4％（70／81）和73．1％（68／93）,差异有统计学意义（P=0．039）。两组手术时间分别为（130±15）min和（125±20）min,术中出血量分别为（100±15）ml和（95±10）ml,差异均无统计学意义（P〉0．05）。两组术后并发症发生率分别为9．9％（8／81）和9．7％（9／93）,差异无统计学意义（P〉0．05）。结论术前放化疗能够显著提高中低位直肠癌患者的保肛率。且并不会增加手术难度和术后并发症的发生率。

Impacts of preoperative radiochemotherapy on operation and postoperative complications in patients with mid-low rectal carcinomas

Objective To investigate the impact of preoperative radiochemotherapy on postoperative complications in patients with mid-low rectal carcinomas. Methods Clinicopathologic data of T3 and T4 patients with mid-low rectal carcinomas in the Department of Colorectal Surgery at the Changhai Hospital of The Second Military Medical University from January 2009 to December 2010 were analyzed retrospectively. This cohort included 81 patients treated with preoperative radiochemotherapy followed by operation （radiochemotherapy group） and 93 cases who underwent surgery alone （control group）. Results Both resection rate and sphincter preservation rate were higher in the radiochemotherapy group （100% and 86.4% ） than those in the control group （94.6% and 73.1%）, and the difference in sphincter preservation rate was statistically significant （P=0.039）. There were no significant differences in the mean operative time （130±15） min vs. （125±20） min, P〉0.05 ] and mean amount of bleeding （100±15） ml vs. （95±10） ml, P〉0.05 ] between the two groups. The overall incidence of postoperative complications was similar（9.9% vs. 9.7%, P〉0.05 ）. Conclusions Preoperative radiochemotherapy can significantly increase sphincter preservation rate of mid-low rectal carcinomas, and does not increase the difficulty in surgical procedure and postoperative complications.