CAJ | 학술논문

目的探讨新辅助化放疗对局部进展期直肠癌低位前切除术后吻合13愈合的影响.方法收集2001年5月至2007年8月的低位直肠癌(距肛缘≤6 cm)患者192例.全部病例均经术前化放疗.放疗40～46 Gy/20～23次,每周5次,每次2 Gy.放疗结束后休息六周.放疗同时进行化疗,口服卡培他滨1250 mg/(m~2·d),每日2次口服,直至手术.手术遵循TME原则进行.分析低位直肠癌术后吻合口漏发生情况.结果全部病例完成术前化放疗.17例术前复查肿瘤完全消失(8.9%),未再进行手术治疗.手术前复查无一例发现肿瘤有进一步发展或转移.24例术后病理提示肿瘤完全消失,故肿瘤完全消失者共41例(21.4%).175例患者均按TME原则进行直肠癌根治术.保肛手术166例,保肛率为95.3%.其中低位直肠癌前切除术(LAR,双吻合器)134例,Parks术32例.腹会阴切除术6例.Hartmann术3例.在所有保肛患者中,发生吻合口漏9例,发生率为5.1%.LAR(双吻合器)术后发生吻合口漏6例,发生率为4.4%,其中直肠阴道漏4例.Parks术后吻合口漏3例,发生率为9.4%,其中直肠阴道漏1例.两组保肛手术吻合口漏发生率无显著差异(P＞0.05).吻合口漏发生时间为术后2～10 d,均经相应处理后获得良好结果 .结论合理运用新辅助化放疗不会明显增加低位直肠癌术后吻合口漏的发生.
목적 탐토신보조화방료대국부진전기직장암저위전절제술후문합13유합적영향.방법 수집2001년5월지2007년8월적저위직장암(거항연≤6 cm)환자192례.전부병례균경술전화방료.방료40～46 Gy/20～23차,매주5차,매차2 Gy.방료결속후휴식륙주.방료동시진행화료,구복잡배타빈1250 mg/(m~2·d),매일2차구복,직지수술.수술준순TME원칙진행.분석저위직장암술후문합구루발생정황.결과 전부병례완성술전화방료.17례술전복사종류완전소실(8.9%),미재진행수술치료.수술전복사무일례발현종류유진일보발전혹전이.24례술후병리제시종류완전소실,고종류완전소실자공41례(21.4%).175례환자균안TME원칙진행직장암근치술.보항수술166례,보항솔위95.3%.기중저위직장암전절제술(LAR,쌍문합기)134례,Parks술32례.복회음절제술6례.Hartmann술3례.재소유보항환자중,발생문합구루9례,발생솔위5.1%.LAR(쌍문합기)술후발생문합구루6례,발생솔위4.4%,기중직장음도루4례.Parks술후문합구루3례,발생솔위9.4%,기중직장음도루1례.량조보항수술문합구루발생솔무현저차이(P＞0.05).문합구루발생시간위술후2～10 d,균경상응처리후획득량호결과 .결론 합리운용신보조화방료불회명현증가저위직장암술후문합구루적발생.
Objective To investigate the effect of the neoadjuvant chemoradiotherapy (NCR) on the healing of anastomosis following low anterior resection in patients with locally advanced rectal cancer.Methods Between May 2001 and August 2007,192 patients with T3 and T4 low rectal cancer (distance from the tumor to anal verge≤6 cm)enrolled in the study.All patients were subjected to preoperative radiotherapy to pelvis,with a total dose of 40-46 Gy in 20 days fractions of 2 Gy each in 4 weeks and simuhaneously combined with oral capecitabine (CAP) of 1250 mg/m~2 bid continuously for 10 weeks up to surgery.The patients were operated on 6 weeks after the end of radiotherapy according to the rule of TME technique.Results All patients fulfilled the study.Of the patients.17 cases were diagnosed tumor free after the neoadjuvant therapy and were not operated on.Other 24 cases were found got complete tumor response with pathological examination after the operation.A total of 41 cases(21.4%)got complete tumor response with the neoadjuvant therapy.Surgery was performed in 175 patients,and 166 patients (95.3%) with sphincter-saving resection,134 patients with low anterior resection (LAR,double stapling technique) and 32 patients witll Park's endoanal anastomosis.Six patients were operated with abdominoperineal resection (APR) and 3 patients with Hartmann's procedure.Anastomotic leakage was found in 9 patients (5.1%),6 patients (4 cases of rectovaginal leakage) with LAR (double stapling technique) and 3 patients (1 case of reetovagihal leakage) with Parks technique (P＞0.05).Anastomotic leakage occurred in 2-10 days post operation,and were managed properly and got desirable results.Conclusion Neoadjuvant chemoradiotherapy would not affect the healing of anastomosis obviously if being applied reasonably in locally advanced low rectal cancer.