CAJ | 학술논문

目的：观察术中灌注化疗在Dukes C期直肠癌根治术中的临床效果。方法将80例Dukes C期直肠癌患者随机分为两组：观察组40例，在根治性直肠癌全直肠系膜切除术（ TME）中行直肠上动脉、肠系膜下静脉、肠腔及腹腔灌注化疗；对照组40例单行TME。两组术后均采用奥沙利铂＋5-氟尿嘧啶／亚叶酸钙方案规范化疗6个月。比较两组患者术前、术后癌胚抗原（ CEA）水平；术后1、2、3、5年生存率、局部复发率及远处转移率。结果观察组1、2、3、5年生存率分别为87．5％、77．2％、71．7％、44．8％，对照组分别为69．8％、46．6％、38．8％、11．1％，观察组1、2、3、5年生存率明显高于对照组（P＜0．05）。观察组术后血清CEA水平降低趋势较对照组明显（P＜0．05）。术后5年观察组局部复发率27．5％、远处转移率17．5％，均低于对照组的50．0％、37．5％（ P＜0．05）。结论 Dukes C期直肠癌TME术中灌注化疗安全有效，可降低术后复发率、远处转移率，能提高患者的生存率，延长生存时间。
목적：관찰술중관주화료재Dukes C기직장암근치술중적림상효과。방법장80례Dukes C기직장암환자수궤분위량조：관찰조40례，재근치성직장암전직장계막절제술（ TME）중행직장상동맥、장계막하정맥、장강급복강관주화료；대조조40례단행TME。량조술후균채용오사리박＋5-불뇨밀정／아협산개방안규범화료6개월。비교량조환자술전、술후암배항원（ CEA）수평；술후1、2、3、5년생존솔、국부복발솔급원처전이솔。결과관찰조1、2、3、5년생존솔분별위87．5％、77．2％、71．7％、44．8％，대조조분별위69．8％、46．6％、38．8％、11．1％，관찰조1、2、3、5년생존솔명현고우대조조（P＜0．05）。관찰조술후혈청CEA수평강저추세교대조조명현（P＜0．05）。술후5년관찰조국부복발솔27．5％、원처전이솔17．5％，균저우대조조적50．0％、37．5％（ P＜0．05）。결론 Dukes C기직장암TME술중관주화료안전유효，가강저술후복발솔、원처전이솔，능제고환자적생존솔，연장생존시간。
Objective To observe the clinical effect of intraoperative perfusion chemotherapy on patients with rectal carcinoma of Dukes′stage C during radical operation .Methods Eighty patients with Dukes′stage C rectal carcinoma were randomly divided into two groups.Forty cases in the observation group received radical total mesorectal excision (TME) plus rectal artery ,inferior mesenteric vein ,intestinal cavity and abdominal cavity perfusion chemotherapy .Forty patients in the control group received TME alone .The patients in two groups were given a standard chemotherapy regimen of oxaliplatin plus 5-Fu/CF for 6 months.The levels of carcinoembryonic antigen ( CEA) before and after operation ,and 1-,2-,3-,5-year survival rates after operation ,local recurrence rate and distant metastasis rate were compared between two groups .Results The 1-,2-,3-,5-year survival rates in the observation group were 87.5%,77.2%,71.7%,44.8%,respectively.The 1-,2-, 3-,5-year survival rates in the control group were 69.8%,46.6%,38.8%,11.1%,respectively .The survival rate of observation group was higher than that of control group (P<0.05).The serum CEA level after operation in the observation group decreased significantly compared with the controls ( P<0.05) .Five years after operation ,the local recurrence rate and distant metastasis rate in the observation group were superior to those in the control group ( 27.5% vs.50.0%, 17.5%vs.37.5%,P<0.05).Conclusion Intraoperative perfusion chemotherapy combined with TME for Dukes′stage C rectal carcinoma is safe and effective ,which can increase the patient′s survival rate and prolong the survival time.