摘要
目的 通过在多学科协作诊治模式下运用不同周期的结直肠癌新辅助化疗联合手术的多种方案，探讨适合于我国结直肠癌患者的有效治疗方案。方法 回顾性研究了2006年10月至2007年4月期间四川大学华西医院普外三科收治的结直肠癌患者，并根据新辅助化疗的周期数将资料分为单周期组、双周期组和三周期组，比较3组在运用不同周期新辅助化疗和手术的联合方案下治疗时间、新辅助化疗效果、手术结果等指标之间的差异。结果从新辅助化疗完成到手术时间3组（单周期组（5，64±2．00）d，双周期组（5．80±3．74）d，三周期组（6．22±2．76）d3间差异无统计学意义（P〉0．05）。从治疗效果上看，3组内新辅助化疗后较化疗前的CEA值均有下降（P〈0．01）；双周期组和三周期组患者的便血、肛门坠胀／刺激感、大便不畅感等主观感受指标比单周期组明显改善（P〈0．01）。在评估肿瘤病灶缓解情况中，双周期组和三周期组中出现CR和PR的构成比较单周期组更多，肿瘤缓解率（CR＋PR）更高（P〈0．01）。而新辅助化疗的治疗不良反应中，新辅助化疗后较化疗前的WBC值在双周期组和三周期组内均明显下降（P〈0．01），新辅助化疗前后WBC差值，在单周期组[（0．16±0．20）×10^9。／L）分别比双周期组[（2．41±2．16）×10^9／L）和三周期组[（2．63±1．48）×10^9／L）下降更少（P〈0．01）。三周期组的恶心和呕吐反应明显多于单周期组（P〈0．01）和双周期组（P〈0．01）；但是腹胀和腹泻反应在3组之间差异无统计学意义（P〉0．05）。采用不同的新辅助化疗周期患者对方案接受程度的调查发现，单周期组和双周期组对于方案的接受程度均为100％，并表示有信心进行辅助化疗；而三周期组的方案接受率为66．7％（12／18）。所有患者均顺利完成手术，手术后肛门排气时间单周期组与双周期组间差异有统计学意义（P〈0.05）；术后进食时间，三周期组与单周期组、三周期组与双周期组的患者之间的差异均有统计学意义（P〈0．05）。而3组在伤口愈合时间上差异无统计学意义（P〉0．05）。结论 综合分析新辅助化疗周期与手术安排之间的时间、治疗效果和手术结果，选择双周期短时间的新辅助治疗方案对我国西部地区患者可能是一套具有可行性和安全性的结直肠癌多学科治疗方案。
Objective Through using neoadjuvant chemotherapy of different circles combined colorectal cancer operations under multi-disciplinary team （MDT）, we evaluate effective treatment strategies that suit to colorectal cancer patients in this country. Methods The retrospective study reviewed patients with colorectal cancer treated in general surgery department HI in West China Hospital of Sichuan University from October 2006 to April 2007. According to the circle times of neoadjuvant chemotherapy, the patients were divided into single-circle group, doublecircle group and triple-circle group. And comparing the difference of treatment time, effect index of neoadjuvant chemotherapy and operative results used these stratagies. Results The difference between the time from the end of neoadjuvant chemotherapy to the operation in three groups had no statistical significance （P〉0.05）, which were （5.64±2.00） d in single-circle group, （ 5. 80± 3.74） d in double-circle group, （ 6.22 ± 2.76） d in triple-circle group. According to the treatment effects, CEA value decreased during pre- and post-neoadjuvant chemotherapy in each groups （P〈0.01）. Subjective reception such as hemafecia, anal tenemus and defecation obstruction in double-circle group and triple-circle group were obviously improved than that in single-circle group （P〈0.01）. Evaluating the tumor condition, the ratio of CR and PR in double-circle group and triple-circle group was higher than that in single-circle group （P〈0.01）. According to the adverse effect, WBC value of double-circle group and triple-circle group decreased during pre- and post-neoadjuvant chemotherapy, their difference had statistical significance （P〈0.01）. The difference of WBC pre- and post- neoadjuvant chemotherapy in single-circle group decreased fewer than that in double-circle group and triple-circle group （P〈0.01）. Nausea and vomit response in triple-circle group were obviously more serious than that in single-circle group and double-circle group （P〈0.01）. But abdominal distention and diarrhea response had no difference among three groups （P〉0.05）. Through our survey, used different neoadjuvant chemotherapy circle, patients in single-circle group and double-circle group were completely accepted within full confidence; but receptance of strategy in triple-circle group was 66.7% （12/18）. All operations were successful. The difference of postoperative aerofluxus time between single-circle group and double-circle group had statistical significance （P〈0.05）. The difference of postoperative intake time, between triple-circle group and singlecircle group, between triple-circle group and double-circle group, had statistical significance （P〈0.05）. But wound recover time among three groups had no obvious difference （P〉0.05）. Conclusion Analyzing neoadjuvant chemotherapy circles, time between neoadjuvant chemotherapy and operation, treatment effect and operation results, it is a feasible and secure colorectal cancer multi-discipinary strategy for patients in West China that choose the treatment of neoadjuvant chemotherapy with double-circle and short preparation time.
出处
《中国普外基础与临床杂志》
CAS
2008年第3期210-214,217,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
多学科协作诊治
结直肠癌
新辅助化疗
手术
Multi-discipinary treatment Colorectal cancer Neoadjuvant chemotherapy Operation
