摘要
目的探讨Ⅰ期急诊回肠造口解除梗阻加新辅助放化疗,Ⅱ期根治性手术切除治疗梗阻性结直肠癌的临床应用价值。方法回顾总结我院2004年1月～2008年12月间64例梗阻性结直肠癌患者行Ⅰ期回肠造口加新辅助治疗(A组),Ⅱ期根治性切除的临床和随访资料,并与同期(B组)75例梗阻性结直肠癌患者行Ⅰ期根治性切除的相应资料进行对比分析。结果 A组病例在急性生理改变及慢性健康状况评分(APACHEⅡ)于急诊手术前高于B组(P<0.01)。两组肿瘤的临床分期(cTNM)无显著差别。新辅助放化疗对梗阻性结直肠癌的治疗有效率为82.8%(53/64)。其中临床完全缓解率7.8%(5/64)。行根治手术后A组的切口感染、盆腹腔感染、吻合口漏发生率分别为7.8%(5/64)、6.25%(4/64)和4.7%(3/64),明显低于B组的21.3%(16/75)、18.7%(14/75)和14.7%(11/75)。P<0.01差异有显著意义。而A组的三年无病生存率为59.4%(38/64)高于B组的49.3%(37/75),差异有显著意义(P<0.05)。结论新辅助放化疗对梗阻性结直肠癌有治疗价值,配合Ⅰ期回肠造口解除梗阻,Ⅱ期根治性手术切除治疗梗阻性结直肠癌的效果要好于Ⅰ期根治性手术。
Objective To investigate clinical value of Ⅰstage ileostomy plus neoadjuvant therapy and Ⅱ stage radical resection for obstructive colorectal cancer. Methods A total of 139 patients with obstructive colorectal cancer were treated with different therapeutic strategy and were followed and analyzed. Of 139 cases, 64 cases （A group） were treated by Ⅰstage ileostomy plus neoadjuvant therapy and Ⅱ stage radical resection, and 75 cases （B group） underwent Ⅰ stage radical resection. Severity of illness for all patients was evaluated by a score of Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ）. Results APACHEⅡ score of group A was higher than that of group B（P0.01）. Clinnical stage （cTNM） showed no significant difference between two groups （P0.05）. The clinical response rate of neoadjuvant therapy for colorectal cancer was 82.8% （53/64）, and the clinical complete response rate was 7.8 （5/64）. After radical resection, the rate of incision infection,pelvic cava infection,and anastomosis leakage in group A were lower than in group B （P0.05）. The 3 year disease free survival rate （3 year DFSR） was 59.4% （38/64） in group A, wihich was lower than that in group B（49.3%）. Conclusions Neoadjuvant therapy is effective in treating obstructive colorectal cancer,and the efficacy of Ⅰstage ileostomy plus neoadjuvant therapy and Ⅱstage radical resection is higher than that of Ⅰ stage radical resection in treating obstructive colorectal cancer.
出处
《岭南现代临床外科》
2012年第2期115-117,共3页
Lingnan Modern Clinics in Surgery
