摘要
中低位直肠癌最主要的治疗手段目前仍然是手术根治性切除，但近10余年间治疗策略发生了很大的变化。以往，术前诊断的重点是定性诊断，强调的是手术的根治性或能否保肛。当前，直肠癌术前分期诊断受到重视，针对不同分期选择治疗方式及术式，使病人最大限度的收益。对于不伴有不良预后因素的T1NOM0期早期直肠癌可以慎重选择局部切除术；对于局部中晚期直肠癌[T3～4期和（或）伴有区域性淋巴结转移]推荐术前放化疗然后再行手术；而对于伴有肝、肺等远处转移的直肠癌病人，根据情况决定原发病灶是否需要切除。
Although radical resection is the mainstay of treatment for middle and low rectal cancer, there have been substantial changes in the strategies of treatment in the last decade. Previously, the purpose of preoperative assessment was mainly qualitative, determining whether or not radical surgery or sphincter-preserving operations could be performed based on tumor localization and etiologic diagnosis. Nowadays, the preoperative diagnosis addresses selection of appropriate therapeutic strategies and surgical modalities according to different stages for the sake of offering the biggest benefits to patients. Local excision is usually selected for patients with T1NOM0 rectal cancer without adverse prognostic factors. Preoperative chemoradiation is recommended for patients with locally advanced rectal cancer （T3-4 and/or N1-2 stage without distant metastasis）. For patients with distal pulmonary and hepatic metastasis, whether the primary lesion should be resected or not depends on the patient general condition. Withthe proper application of these strategies, the therapeutic outcome of middle and low rectal cancer has been improved markedly in the last decade. However, some new problems have also arisen out of utilization of the new techniques.
出处
《中国实用外科杂志》
CSCD
北大核心
2012年第9期744-747,共4页
Chinese Journal of Practical Surgery
关键词
中低位直肠癌
术前评估
治疗策略
middle and low rectal cancer
preoperativeassessment
strategies of treatment
