摘要
结直肠癌发病率和死亡率仍呈上升趋势，2002年全球结直肠癌新发病例102．3万，死亡52.9万，分别比2000年增加8．3％和7．5％。其发病率和死亡率分别居所有癌症的第三位和第四位。中国亦不例外，结直肠癌死亡率2005年比1991年增加70．7％，年均增加4．71％。因此，迄今许多国家仍然把结直肠癌作为重点肿瘤进行研究。本文着重介绍直肠癌近年来的治疗进展。外科方面保肛手术日益受到重视，所占比例越来越高，这主要是手术技术提高、全直肠系膜切除术（TME）推广、吻合器的应用，但更重要的是越来越多学者接受远端安全切缘为1—2cm的意见。TME事实上已作为直肠癌手术的”金标准”。因为TME技术原则使局部复发率由35％-45％下降到3％-11％。微创手术也是近年颇受重视的新技术。腹腔镜下结肠癌切除较为成熟，但仍需注意选择适应征。直肠癌扩大根治术使腹膜返折以下进展期直肠癌的术后5年生存率提高到68％。但要进一步提高直肠癌手术效果还要多学科综合治疗，特别是术前放化疗显示出良好的势头。但是还有许多具体问题，有待进一步开展多中心临床试验加以解决。
Incidence and mortality of eolorectal cancer（CRC） are rising. There were one million and twenty-three thousand new cases and five hundred and twenty-nine thousand deaths in 2002, which were 8.3% and 7.5% more than that in 2000, respectively. Incidence and mortality of CRC take the third and forth place in all cancers. Mortality in China has increased by 70.7% since 1991, by 4.71% per year in average. Therefore, CRC is one of the heat points in cancer research. In this paper, we focused on the progress in treatment for rectal cancer, Sphincter-preserved resection has an increasing proportion in surgical procedures, owing to improvement of technique, TME and the staplers. Above all, the most important reason seems to be the popular opinion that distal margin of 1 to 2 centimeters is safe enough. TME acts as a ＂ gold standard＂ in rectal cancer resection, due to its magnificent potential in controlling local recurrence which had decreased from 35% -45% to 3% -11%. Microsurgery is a band-new technique. Laparoscopic colon resection is satisfactory with selective cases. Extended resection results in improving 5-year survival of advanced rectal cancer distal to the reflection to 68%. Further improvement of the outcome depends on multiple modality regimens. Neoadjuvant chemoradiotherapy shows an exciting prospect in some trials. But more multicenter clinical trials are needed to solve the remaining problems.
出处
《中国癌症杂志》
CAS
CSCD
2006年第10期765-770,共6页
China Oncology
关键词
直肠癌
外科手术
放疗
化疗
rectal cancer
surgery
radiotherapy
chemotherapy
