手术中种植放射碘-125微粒近距离放疗在低位直肠癌综合治疗中的应用

 目的　探讨组织间种植放射碘 12 5 (12 5I)微粒近距离放疗在低位直肠癌综合治疗中的应用。方法　可手术低位直肠癌 82例 ,肿瘤距肛缘在 4～ 6cm者分为盆腔自主神经保留 (PANP)加肛门重建术(ARO)加12 5I微粒种植组 (实验组 :A组 )和Miles手术组 (对照组 :B组 ) ;肿瘤距肛缘 6～ 8cm者分为超低位前切除 (ASP)加PANP加12 5I微粒种植组 (实验组 :C组 )和ASP组 (对照组 :D组 )。随访比较各组间局部复发率、5年生存率、排便功能和性功能障碍等。结果　A与B组及C与D组间局部复发率、控便功能、排尿和性功能障碍发生率、5年生存率差异有统计学意义 (P <0 .0 5 ) ,A、C两组术后局部复发率、排尿功能和性功能障碍发生率分别低于对照组B、D组 (P <0 .0 1)。而术后吻合口瘘、吻合口狭窄和骨盆腔感染的发生率差异无统计学意义。结论　组织间永久性种植12 5I微粒近距离放疗疗效可靠 ,可降低Miles手术的比例 ,有效预防功能保存手术后的局部复发 ,提高 5年生存率和病人的生存质量。

Brachytherapy with Interstitial Iodine-125 seeds implantation on operation for synthetic therapy of low rectal carcinomas

Objective To evaluate the efficacy of interstitial Iodine-125 ( 125 I)brachytherapy in the combined treatment of low rectal carcinomas. Methods 82 curable patients with rectal cancer at low height enrolled in the experiment were divided into two groups according to tumor location. Tumor at height from 4 to 6cm were performed anus reconstructed operation(ARO) plus pelvic autonomic nerve preserved operation(PANP) plus interstitial 125 I implantation (experimental group, marked A) and Miles' operation(control group, marked B).Tumor at height from 6 to 8cm were performed anal sphincter preserved operation(ASP) and PANP plus 125 I embedding (experimental group, marked C) and low anterior resection(control group,maked D). By follow-ups, the rates of local recurrence, difficult urination and defecation, sexual disturbance and 5-year survival rate of experimental groups were compared with control groups. Results The recurrence rates of local relapse, difficult urination and defecation, and sexual disturbance in group A and C were lower than those in the control groups respectively ( P < 0.01 ), whereas the 5-year survival rates were higher ( P < 0.05 ). No significant difference was shown in between each groups on the complications related to 125 I irradiation. Conclusion The results suggest that the curative effect of interstitial 125 I irradiation was reliable, it can reduce the proportion of Miles' operation, cut-down the 5-year recurrence rate, increase the 5-year survival rate and ameliorate the postoperative life of the patients with low rectal carcinomas.