新辅助化疗联合腹腔镜下中低位直肠癌保肛手术的临床效果

目的 探讨新辅助化疗联合腹腔镜手术在中低位直肠癌保肛治疗中的应用价值.方法 选择我院2007年1月-2012年12月收治的可切除的中低位直肠癌54例,分为辅助化疗组24例和对照组30例,两组均行腹腔镜下直肠癌手术治疗,辅助化疗组术前行3周期FOLFOX4方案（奥沙利铂＋亚叶酸钙＋氟尿嘧啶）新辅助化疗,对照组不行任何放化疗.结果 辅助化疗组41.6％的病例肿瘤体积缩小、变软,肿瘤距肛缘距离增加,保肛率为75.0％;对照组保肛率为46.7％,差异有统计学意义（P＜0.05）;经腹直肠前切除术比例、淋巴结转移比例与对照组比较,差异均有统计学意义（P＜0.05）.结论 术前新辅助化疗联合腹腔镜手术可显著提高中低位直肠癌的根治率及保肛率.

Clinical Effect of Neoadjuvant Chemotherapy Combined with Laparoscopic Resection in Mid-low Rectal Carcinoma with Sphincter Preservation Procedure

Objective To evaluate the value of neoadjuvant chemotherapy combined with laparoscopic surgery in mid-low rectal carcinoma with sphincter preservation procedure.Methods A total of 54 inpatients with resectable mid-low rectal cancer during January 2007 and December 2012 were divided into neoadjuvant chemotherapy group （group A,n =24） and control group （n =30）.Group A was treated with laparoscopic surgery after three circles of neoadjuvant chemotherapy （FOLFOX4,Oxaliplatin ＋ Calcium folinate ＋ Fluracil）,while control group only underwent laparoscopic surgery without taking chemotherapy or radiotherapy.Results In group A,41.6％ of patients showed a decreased gross tumor volume and softened tumors,and the lengthened distance between tumor and anus.The preservation rate of the anal sphincter were 75.0％ in group A and 46.7％ in control group,and the difference was statistically significant （P ＜ 0.05） ; the differences in ratios of anterior resection of rectum and lymph node metastasis in the two groups were statistically significant （P ＜ 0.05）.Conclusion Preoperative neoadjuvant chemotherapy combined with laparoscopic resection can obviously improve the radical treatment rate and preservation rate of the anal sphincter for mid-low rectal carcinoma.