摘要
我国直肠癌发病率要高于结肠癌,且临床多数直肠癌患者在确诊时已属于中晚期,约有9.3%~15.0%的直肠癌会伴有肠梗阻表现。对于可切除的梗阻性直肠癌(obstructive rectal cancer,ORC)的治疗方案目前临床并无统一意见。随着各种医疗技术的进步,传统的三期手术逐步被替代,虽然临床选择一期切除吻合的情况也较为常见,但是由于ORC通常都是Ⅱ期以上的病情,且多数患者一般情况不佳,所以临床越来越多的选择金属支架(metallic stents,MS)或经肛肠梗阻导管(transanal drainage tubes,TDT)作为手术桥(bridge to surgery,BTS),调整患者情况后再择期手术治疗。由于BTS的应用,新辅助治疗在ORC患者临床研究也逐步展开。ORC患者可选择的治疗方式增多了,但这并不意味着治疗效果的改善。哪种方式最合理已经不仅仅是外科医生需要思考的问题,多学科综合治疗(multidisciplinary treatment,MDT)已然成为趋势。文章就ORC围手术期的治疗进行综述。
The incidence of rectal cancer is higher than that of colon cancer in China.Most patients with rectal cancer are in the advanced stage at the time of diagnosis,and about 9.3%-15.0%of rectal cancer is accompanied by intestinal obstruction.There is currently no clinical consensus on the treatment options for resectable obstructive rectal cancer(ORC).With the advancement of various medical technologies,the traditional three-stage surgery has been gradually replaced.Although it is common to choose a one-stage resection anastomosis,since ORC is usually a stage II or higher condition and most patients are in poor general condition,metal stents or transanal drainage tubes are increasingly chosen clinically as a bridge to surgery(BTS)to adjust the patient’s condition before elective surgical treatment.Due to the use of BTS,clinical studies on neoadjuvant therapy in ORC patients have been gradually conducted.Although there are more treatment options available for patients with ORC,this does not mean an improvement in the treatment effectiveness.Which treatment is the most reasonable is not only a question for surgeons to think about,but also the trend of multidisciplinary treatment.This article reviews the perioperative treatment of ORC.
作者
唐骁文
崔荣
张华宇
TANG Xiao-wen;CUI Rong;ZHANG Hua-yu(Department of General Surgery,Shanghai Jiading Hospital of Traditional Chinese Medicine,Shanghai 201899,China)
出处
《实用临床医学（江西）》
CAS
2023年第5期122-128,共7页
Practical Clinical Medicine
关键词
梗阻性直肠癌
围手术期
手术桥
新辅助治疗
多学科综合治疗
obstructive rectal cancer
perioperative period
bridge to surgery
neoadjuvant therapy
multidisciplinary treatment
