国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2011年
8期
511-514
,共4页
彭开勤%邵永胜%张应天%胡赤丁%余阳%吴文良
彭開勤%邵永勝%張應天%鬍赤丁%餘暘%吳文良
팽개근%소영성%장응천%호적정%여양%오문량
直肠肿瘤%新辅助治疗%分期%降期
直腸腫瘤%新輔助治療%分期%降期
직장종류%신보조치료%분기%강기
Rectal neoplasms%Neoadjuvant therapy%Staging%Downstaging
目的 探讨局部进展期直肠癌新辅助治疗与手术间隔时间对降期疗效的影响.方法 2003年5月-2008年12月为前期,T3/T4期直肠癌32例,新辅助治疗结束4～6周后手术;2009年1月-2010年12月为后期,T3/T4期直肠癌21例,新辅助治疗结束8周后手术.比较两组患者的术后Dworak分级、TNM分期和临床结局.结果 本组所有病例皆为RO切除,无手术死亡和吻合口瘘并发症.前期病例5例Dworak分级3级,3例Dworak分级2级,24例Dworak分级1级;后期病例2例Dworak分级4级,5例Dworak分级3级,6例Dworak分级2级,8例Dworak分级1级(x2=9.109,P=0.028).前期病例6例ypT1N0M0期,22例ypT2N0M0期,1例ypT3N0M0期,3例ypT3N1M0期;后期病例13例ypT1N0M0期,6例ypT2N0M0期,1例ypT3N0M0期,1例ypT3N1M0期(x2=10.909,P=0.012).前期病例保肛率为65.6%,后期病例保肛率为81.0%(x2=1.468,P=0.226).结论 新辅助治疗结束8周后手术,可以获得更为明显的降期效果.延长新辅助治疗与手术的间隔时间,对临床结局的影响有待进一步观察.
目的 探討跼部進展期直腸癌新輔助治療與手術間隔時間對降期療效的影響.方法 2003年5月-2008年12月為前期,T3/T4期直腸癌32例,新輔助治療結束4～6週後手術;2009年1月-2010年12月為後期,T3/T4期直腸癌21例,新輔助治療結束8週後手術.比較兩組患者的術後Dworak分級、TNM分期和臨床結跼.結果 本組所有病例皆為RO切除,無手術死亡和吻閤口瘺併髮癥.前期病例5例Dworak分級3級,3例Dworak分級2級,24例Dworak分級1級;後期病例2例Dworak分級4級,5例Dworak分級3級,6例Dworak分級2級,8例Dworak分級1級(x2=9.109,P=0.028).前期病例6例ypT1N0M0期,22例ypT2N0M0期,1例ypT3N0M0期,3例ypT3N1M0期;後期病例13例ypT1N0M0期,6例ypT2N0M0期,1例ypT3N0M0期,1例ypT3N1M0期(x2=10.909,P=0.012).前期病例保肛率為65.6%,後期病例保肛率為81.0%(x2=1.468,P=0.226).結論 新輔助治療結束8週後手術,可以穫得更為明顯的降期效果.延長新輔助治療與手術的間隔時間,對臨床結跼的影響有待進一步觀察.
목적 탐토국부진전기직장암신보조치료여수술간격시간대강기료효적영향.방법 2003년5월-2008년12월위전기,T3/T4기직장암32례,신보조치료결속4～6주후수술;2009년1월-2010년12월위후기,T3/T4기직장암21례,신보조치료결속8주후수술.비교량조환자적술후Dworak분급、TNM분기화림상결국.결과 본조소유병례개위RO절제,무수술사망화문합구루병발증.전기병례5례Dworak분급3급,3례Dworak분급2급,24례Dworak분급1급;후기병례2례Dworak분급4급,5례Dworak분급3급,6례Dworak분급2급,8례Dworak분급1급(x2=9.109,P=0.028).전기병례6례ypT1N0M0기,22례ypT2N0M0기,1례ypT3N0M0기,3례ypT3N1M0기;후기병례13례ypT1N0M0기,6례ypT2N0M0기,1례ypT3N0M0기,1례ypT3N1M0기(x2=10.909,P=0.012).전기병례보항솔위65.6%,후기병례보항솔위81.0%(x2=1.468,P=0.226).결론 신보조치료결속8주후수술,가이획득경위명현적강기효과.연장신보조치료여수술적간격시간,대림상결국적영향유대진일보관찰.
Objective To discuss the effect of the interval between neoadjuvant therapy and surgery on downstaging for local advanced rectal cancer.Method s From May 2003 to December 2008 as earlier period,32 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 4 -6 weeks.From January 2009 to December 2010 as later period,21 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 8 weeks.Dworak classification,TNM stage and clinical outcome after surgery were compared between two group paitents.Results All patients with local advanced rectal cancer received R0 resection.No surgical complications and mortality were observed in all cases.Pathological results showed that 0 and 2 cases were Dworak classification Ⅳ,5 cases were Dworak classification Ⅲ,3 and 6 cases were Dworak classification Ⅱ and 24 and 8 cases were Dworak classification Ⅰ in earlier period and later period,respectively (x2 = 9.109,P = 0.028).The postoperative staging showed that 6 and 13 cases were ypT1N0M0,22 and 6 cases were ypT2N0M0,1 case was ypT3 N0M0,3 and 1 cases were ypT3N1 M0,respectively (x2 = 10.909,P = 0.012).There were 65.6% or 81.0% cases reserved anus in earlier period and later period,respectively(x2 = 1.468,P = 0.226).Conclusions The neoadjuvant therapy followed by surgery after 8 weeks is associated with a more significant downstaging effect for local advanced rectal cancer.However,the effect of an extended interval between neoadjuvant therapy and surgery on clinical outcome still needs further investigation.
