新辅助放化疗对腹腔镜中低位直肠癌根治术围术期结果的影响

发布时间：2018-03-04 09:17

本文选题：新辅助放化疗　切入点：腹腔镜根治术　出处：《中国微创外科杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的对比新辅助放化疗组与直接手术组腹腔镜中低位直肠癌根治术的围术期结果,探讨新辅助放化疗对腹腔镜中低位直肠癌根治术围术期结果的影响。方法回顾性分析2012年1月~2015年3月我科收治的符合纳入标准的182例中低位直肠癌患者的临床资料,其中行低位前切除术104例,腹会阴联合切除术71例,Hartmann手术7例。按美国国立综合癌症网络(NCCN)指南均建议行新辅助放化疗,按患者意愿,57例接受新辅助放化疗(新辅助治疗组),125例直接手术(直接手术组)。对2组围手术期资料进行对比分析。结果新辅助放化疗组36例(63.2%)T分期降期,其中13例(22.8%)达到病理完全缓解,清扫淋巴结数目明显少于直接手术组[(8.7±4.6)枚vs.(15.7±4.6)枚,t=-6.872,P=0.000],淋巴结阳性率明显低于直接手术组[15.8%(9/57)vs.60.0%(75/125),χ~2=30.789,P=0.000]。104例低位前切除术中,新辅助治疗组(n=37)行保护性末端回肠造瘘的比例远大于直接手术组(n=67)[83.8%(31/37)vs.26.9%(18/67),χ~2=30.992,P=0.000],新辅助治疗组手术时间更长[(251.7±64.0)min vs.(213.7±69.9)min,t=2.735,P=0.007],2组中转开腹率、吻合口高度、术中出血量、外科并发症发生率、Dindo 3~4级并发症发生率无统计学差异(P0.05)。71例腹会阴联合切除术中,新辅助治疗组(n=17)和直接手术组(n=54)中转开腹率、手术时间、术中出血量、外科并发症发生率、Dindo3~4级并发症发生率以及会阴切口并发症发生率均无统计学差异(P0.05)。结论新辅助放化疗没有增加腹腔镜中低位直肠癌根治术的术中出血量、中转开腹率以及围手术期并发症发生率。但对于保肛手术,新辅助放化疗明显增加保护性末端回肠造瘘的比例,并且导致手术时间延长。
[Abstract]:Objective to compare the perioperative results between neoadjuvant chemoradiotherapy group and direct operation group. To investigate the effect of neoadjuvant radiotherapy and chemotherapy on the perioperative outcome of laparoscopic radical resection of middle and low rectal cancer methods the clinical data of 182 patients with middle and low rectal cancer who were admitted to our department from January 2012 to March 2015 were analyzed retrospectively. There were 104 cases of low anterior resection and 7 cases of combined abdominal perineum resection and Hartmann's operation. According to the guidelines of the National Comprehensive Cancer Network (NCCNN), neoadjuvant radiotherapy and chemotherapy were recommended. According to the wishes of the patients, 57 patients received neoadjuvant radiotherapy and chemotherapy (neoadjuvant therapy group, 125 cases received direct operation (direct operation group). The data of perioperative period in two groups were compared and analyzed. Results 36 cases of neo-adjuvant chemotherapy group received neo-adjuvant radiotherapy and chemotherapy group (n = 36). The total number of dissected lymph nodes was significantly lower in the direct operation group than in the direct operation group [8.7 卤4.6 vs.(15.7 卤4.6). The positive rate of lymph nodes was significantly lower than that in the direct operation group [15.8i / 95.57vs.60.010 / 75 / 125, 蠂 ~ 2 + 30.789P _ (0.000)], and the positive rate of lymph nodes was significantly lower than that in the direct operation group [15.8g / 97.57 / 125a, 蠂 ~ 2 + 30.789P _ (0.000)], and the positive rate of lymph nodes was significantly lower than that in the direct operation group (P < 0.05). In the neo-adjuvant treatment group, the proportion of protective terminal ileostomy was much higher than that in the direct operation group (83.8R / 31.37v s.26.9A = 18 / 67, 蠂 ~ (2 +) + 30.992P ~ (0.000)). The operation time in the neo-adjuvant therapy group was longer than that in the new adjuvant group (vs.(213.7 卤69.9min, vs.(213.7 卤69.9min, 2.735U / P 0.007), the rate of abdominal conversion, the height of anastomosis, the volume of blood loss during operation in the two groups were higher than those in the control group (251.7 卤64.0min, vs.(213.7 卤69.9min, 2.735U, P 0.007). There was no significant difference in the incidence of surgical complications between Dindo 3 and grade 4 complications. In 71 cases of combined abdominal perineum resection, the rate of conversion to laparotomy, the operative time, and the amount of intraoperative bleeding in the neo-adjuvant treatment group (n = 17) and the direct operation group (n = 54) were not significantly different. There was no significant difference in the incidence of surgical complications between Dindo 3 grade 4 complications and perineal incision complications. Conclusion Neo-adjuvant radiotherapy and chemotherapy did not increase the intraoperative bleeding during laparoscopic radical resection of middle and low rectal cancer. The rate of conversion to laparotomy and the incidence of perioperative complications. However neoadjuvant radiotherapy and chemotherapy significantly increased the proportion of protective terminal ileostomy and prolonged the operation time.
【作者单位】：北京大学第三医院普通外科;
【基金】：国家临床重点专科建设项目(06-191730)
【分类号】：R735.37

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