125I粒子植入在低位直肠癌保肛术中的应用

目的探讨低位直肠癌术中永久性植入125I粒子对保留肛门括约肌功能及自主神经的结肠肛管吻合术的临床效果.方法选择低位直肠癌患者76例,随机分为对照组(A组)与治疗组(B组),A组30例行全直肠系膜切除术、保肛手术和术后化疗; B组46例,除A组的治疗方案外,术中永久植入125I粒子.术后两组患者于7 d及3个月观察血常规及免疫球蛋白的变化,3～6个月观察术后患者的排便功能及了解性功能状况.观察6个月、12、24、36个月肿瘤的局部复发率及患者生存率.结果术前、术后1周及3个月内血象虽有显著差异,但均在正常范围,免疫指标与术前无明显变化,无统计学意义.A组6个月、12、24、36个月的局部复发率分别为0%、11.1%、14.3%、23.3%;生存率100%、100%、85.7%、76.7%.B组的则为局部复发率均0%;生存率100%、100%、97.1%,93.0%,两组的局部复发率及生存率有显著性差异(P<0.05).两组患者术后自主排便和性功能障碍有显著差异,B组优于A组(P<0.05).结论结合125I粒子永久植入治疗低位直肠癌保肛手术,方法简便、安全,疗效确切,并能扩展保肛手术适应范围,在保肛术式中具有广泛的应用前景.

125I seed implantation in sphincter preservation for treatment of low rectal cancer

OBJECTIVE: To evaluate the effects of (125)I seed implantation in sphincter preservation for treatment of low rectal cancer. METHODS: Seventy-six patients with low rectal cancer were randomly divided into 2 group: group A, 17 males and 13 females, aged 48.5 +/- 2.4, receiving rectostomy and anal sphincter preservation and group B, 24 males and 22 females, aged 49.4 +/- 2.6, receiving modified TME and anal sphincter preservation combined with brachytherapy by (125)I seed implantation. Two to four weeks after operation chemotherapy with 5-FU/CF were performed. Follow-up was carried out 6, 12, 24, and 36 months after operation. RESULTS: The local recurrence rates 6, 12, 24, and 36 months after operation were 0%, 11.1%, 14.3%, and 23% respectively in the group A, and all 0% in the group B (P < 0.05 for the rate 36 months later). The survival rates 6, 12, 24, and 36 months after operation were 100%, 100%, 85.7%, and 76.7% respectively in the group A, and were 100%, 100%, 97.1%, and 93% respectively in the group B (P < 0.05 for the rate 36 months later). The functions of defecation and erection were better in the group B and the symptom of pain was improved better in the group A too (all P < 0.05). CONCLUSIONS: Safe, simple, and effective, surgery with sphincter preservation combined with brachytherapy in low rectal cancer is one of the ideal methods for treatment of low rectal cancer.