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《低位局部進(jìn)展期直腸癌治療中新輔助同步放化療聯(lián)合tme術(shù)的價(jià)值探究》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在工程資料-天天文庫。
1、低位局部進(jìn)展期直腸癌治療中新輔助同步放化療聯(lián)合TME術(shù)的價(jià)值探宄摘要：目的全直腸系膜切除(totalmesorectalexcision,TME)是目前直腸癌手術(shù)治療的標(biāo)準(zhǔn)方法，但由于其復(fù)雜的結(jié)構(gòu)，局部病灶清除不完全致使切除率降低，術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)高。本文探討新輔助同步放化療聯(lián)合TME術(shù)治療對中低位局部進(jìn)展期直腸癌的有效性和安全性。方法選取本院2011年6月?2013年12月收治的60例中低位局部進(jìn)展期直腸癌患者，包括28例II期(T3-4T0M0)，32例III期(T1-4N1-2M0)。所有患者均接受術(shù)前新輔助放化療(放療總劑量盆腔
2、區(qū)為40?46Gy，瘤床區(qū)為50?56Gy，1.8Gy/次，5次/w,同步化療采用F0LF0X4方案，行2個(gè)周期)。新輔助同步放化療結(jié)束4?6w后根據(jù)TME原則行手術(shù)治療。結(jié)果60例患者均完成新輔助放化療，放化療期間1?2級(jí)不良反應(yīng)發(fā)生率為70.0%,3級(jí)不良反應(yīng)發(fā)生率為10.0%，無4級(jí)不良反應(yīng)發(fā)生。患者臨床TNM分期下降。新輔助放化療結(jié)束后4?6w，60例患者行根治性手術(shù)治療，其中38例行低位或超低位前切除術(shù)(Dixon術(shù))，22例行腹會(huì)陰聯(lián)合切除術(shù)(Miles術(shù))，保肛率75.0%(45/60)。無1例發(fā)生圍手術(shù)期死亡，術(shù)后并
3、發(fā)生癥的總發(fā)生率為13.3%(8/60)。結(jié)論新輔助同步放化療聯(lián)合TME對治療中低位局部進(jìn)展期直腸癌有效并安全，其可以降低腫瘤分期、復(fù)發(fā)率，提高保肛率。關(guān)鍵詞：腸癌；新輔助療法；同步放化療；TME術(shù)Abstract：ObjectiveTME(totalmesorectalexcision,TME)iscurrentlythestandardmethodofsurgicaltreatmentforcolorectalcancer,butbecauseofitscomplexstructure，resultinginpartialdeb
4、ridementincompleteresectionratedecreased，riskofrecurrenceishigh.Thisresearchistoevaluatetheefficacyandsafetyofneoadjuvantconcurrentchemoradiotherapyincombinationwithtotalmesorectalexcision(TME)intreatmentoflocallyadvancedmiddleandlowerrectalcancer.Methods60patientswith
5、locallyadvancedmiddleandlowerrectalcancerinthishospitalsinceJune2011toDecember2013wereselectedastheobservationgroupinthisstudy,and28patientsofwhomhadstageII(T3-4T0M0),32patientshadstageIII(T1-4N1-2M0).Allpatientsreceivedneoadjuvantconcurrentchemoradiotherapy(thedoseofp
6、reoperativeradiotherapywas40-50Gy，1.8Gy/time，5timesperweek；concurrentlycombinedwithtwocyclesofcapecitabine-basedregimen).Thesurgicaloperationwasperformed4?6weeksafterconcurrentchemoradiotherapy.Results60patientscompletedtheneoadjuvantconcurrentchemoradiotherapy.Thetota
7、lrateoflevel1-2adversereactionwas70%,thetotalrateoflevel3adversereactionwas10%，no4adversereaction.Afterradiationandchemotherapy,48cases(80%)ofclinicalTNMstagingweredeclined.60patientsweregivensurgicaloperation,38patientsreceivedlow/ultra-lowanteriorresection(Dixon),22p
8、atientsreceivedabdominoperinealresection(Miles)afterchemoradiotherapyfor4?6weeks.Thesphincterpreservationratewas75.0%
