T3期中低位直肠癌同步放化疗后行保肛手术的临床研究

目的观察术前同步放化疗对T3期中低位直肠癌保肛手术的临床效果。方法分析65例T3期中低位直肠癌临床资料。术前同步放化疗采用常规分割放疗联合化疗方法,放射总剂量为50Gy,每次2 Gy,每周5次。放疗第一周和第五周进行全身化疗,应用5-氟脲嘧啶联合甲酰四氢亚叶酸,每日静脉滴注一次,连续5 d。放化疗结束后4~6周行TME切除加保肛手术。结果65例T3期中低位直肠癌经术前同步放化疗后,27例采用前切除吻合器吻合法,38例采用套入式结肠直肠黏膜吻合术。术前同步放化疗后,有53例（53/65,81.5%）直肠病灶有不同程度缩小。12例（12/65,18.5%）病灶大小无显著变化,同步放化疗前后病灶缩小者所占比例与病灶无变化者有显著性差异（χ2=51.7231,P〈0.01）。65例无手术死亡。术后发生吻合口漏2例（2/65,3.1%）,切口感染1例（1/65,1.5%）。随访时间平均为32个月。局部复发3例（3/65,4.6%）,肺转移1例（1/65,1.5%）,肝转移3例（3/65,4.6%）。3年无病生存率为72.7%。结论对T3期中低位直肠癌行术前同步放化疗可降低保肛术后局部复发率,有助于提高患者术后无病生存率.

Clinical significance of preoperative radiochemotherapy for T3 middle-low rectal cancer with anal sphincter preserving procedure

Objective To study clinical effect of preoperative radiochemotherapy for T3 middle-low rectal cancer with anal sphincter preserving procedure.Methods Sixty-seven cases of T3 middle-lower rectal cancer was investigated.The accumulated dose of preoperative radiotherapy was 50Gy,2 Gy per day,5 days one week.And combined chemotherapy began at the first and the fifth week of the radiotherapy.5-flurouracil and leucovorin were used intravenous,one time per day,5 days one cycle.Total mesorectum excision and anal sp...