新辅助治疗联合3D腹腔镜手术在局部晚期低位直肠癌中的应用体会

目的:评价新辅助治疗在局部晚期低位直肠癌中的疗效及毒副作用,对比3D腹腔镜手术与开腹手术在新辅助治疗后的临床效果,为临床治疗选择提供客观依据。方法:回顾分析2013年2月至2016年1月收治的73例局部进展期低位直肠癌患者的临床资料,患者分为腹腔镜组(n=31)与开放组(n=42),新辅助治疗后进行手术治疗。结果:两组患者新辅助治疗完全缓解率16.4%,部分缓解率53.4%,有效率69.9%。术后病理肿瘤消退分级4级15.1%,3级23.3%,2级35.6%,1级19.2%,0级6.8%。新辅助治疗消化道反应发生率为78.1%,中性粒细胞减低发生率43.8%。术中出血量、术后引流量、排气时间、住院时间及术后疼痛程度腹腔镜组均低于开放组(P0.05)。结论:为低位晚期直肠癌患者行新辅助治疗,可使肿瘤降期,提高根治率、保肛率,改善患者生活质量,新辅助治疗期间的毒副作用可得到良好控制与纠正。结合3D腹腔镜手术可使患者获得更快的康复,并发症与开腹手术相近。

Application of new adjuvant radiochemotherapy combined with three dimension laparoscopy in low rectal regional progressed cancer

Objective:To evaluate the therapeutic and adverse effect of new adjuvant radiochemotherapy in low regional pro -gressed rectal cancer ,compare the clinical effect between three dimension laparoscopic operation and open operation after new adjuvant therapy and to provide bases for clinic .Methods:Seventy-three patients diagnosed as regional progressed low rectal cancer were retro -spectively collected from Feb.2013 to Jan.2016 and were divided into laparoscopic group (31 cases) and open group (42 cases).All patients underwent new adjuvant radiochemotherapy and then operation .Results:The complete response rate was 16 .4%, partial re-sponse rate was 53.4%,effective rate was 69.9%after new adjuvant therapy .The postoperative tumor regression grading was 15.1%, 23.3%,35.6%,19.2%and 6.8%from grade 4 to grade 0.The digestive adverse rate was 78.1%and leucopenia rate was 43.8%. Compared with open group , laparoscopic group was less in bleeding volume in operation , postoperative drainage volume , exhausting time,hospital stay and pain grade (P<0.05).Conclusions:New adjuvant radiochemotherapy in regional progressed low rectal cancer may decrease the grade and increase the radical resection rate and anus preservation rate ,improve the quality of life .The adverse effect of new adjuvant radiochemotherapy can be controlled and corrected .Three dimension laparoscopic operation and new adjuvant radioche-motherapy is associated with quicker recovery and similar complications with laparotomy .