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(P>0.05)。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(P>0.05)。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。
Objective To compare the perioperative outcomes of laparoscopic radical resection for mid-rectal and low-rectal cancer with or without neoadjuvant chemoradiotherapy,and to investigate the impact of neoadjuvant chemoradiotherapy on perioperative outcomes of laparoscopic rectal surgery. Methods Clinical data of mid-rectal and low-rectal cancer patients treated in our hospital between January 2012 and March 2015 were retrospectively collected. One hundred and eighty-two patients met the inclusion criteria,which included 104 cases of low anterior resection,71 cases of abdominoperineal resection and 7 cases of Hartmann resection. All of them were suggested to receive neoadjuvant chemoradiotherapy based on the guideline of National Comprehensive Cancer Network（ NCCN）. Fifty-seven patients underwent neoadjuvant chemoradiotherapy before surgery（ neoadjuvant chemoradiotherapy group）,and the other 125 patients underwent surgery directly（ control group）. Their perioperative data were analyzed. Results Thirty-six（ 63. 2%） patients in the neoadjuvant chemoradiotherapy group achieved T stage downstaging and thirteen（ 22. 8%） patients achieved pathological complete response. Fewer lymph nodes [（ 8. 7 ± 4. 6） nodes vs.（ 15. 7 ± 4. 6） nodes,t =-6. 872,P = 0. 000] were harvested after neoadjuvant chemoradiotherapy,together with a lower lymph node positive rate [15. 8%（ 9 /57） vs. 60. 0%（ 75 /125）,χ^2= 30. 789,P = 0. 000]. In 104 patients undergoing low anterior resection,a significantly higher rate of defunctioning ileostomy [83. 8%（ 31 /37） vs. 26. 9%（ 18 /67）,χ^2= 30. 992,P = 0. 000] and a longer operation time [（ 251. 7 ± 64. 0） min vs.（ 213. 7 ± 69. 9） min,t = 2. 735,P = 0. 007] were observed in the neoadjuvant chemoradiotherapy group,and no significant differences in the conversion rate,height of anastomosis,intraoperative blood loss,surgical morbidity rate and Dindo 3-4 morbidity rate were observed between the two groups（ P〉0. 05）. In 71 patients undergoing abdo
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第3期197-201,共5页
Chinese Journal of Minimally Invasive Surgery
基金
国家临床重点专科建设项目(06-191730)
关键词
新辅助放化疗
腹腔镜根治术
直肠癌
Neoadjuvant chemoradiotherapy
Laparoscopic radical resection
Rectal cancer
