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目的探讨局部晚期低位直肠癌术前放化疗的降期效果和加前切除与Miles手术的远期疗效的比较。方法将103例直肠癌患者分为术前放化疗+前切除组(A组,53例)和Miles手术组(B组,50例)。原发肿瘤距肛门中位距离6.2cm。临床分期Ⅱ期22例,Ⅲ期81例(TNM,UICC)。放疗采用直线加速器盆腔3～4个野照射,剂量35～45Gy,4～5周完成。化疗以氟尿嘧啶为主联合化疗。结果A、B组5年生存率分别为64.2%、43.7%(P<0.05),5年无瘤生存率分别为52.8%、31.6%(P<0.05),局部复发率分别为15.2%、19.3%(P>0.05),远处转移率分别为25.5%、48.5%(含局部复发加远处转移)(P<0.05)。A组术后病理学完全缓解率为13.2%。随访率为88.3%。结论术前放疗和化疗加前切除手术治疗局部晚期低位直肠癌的方法不但能够保肛,而且可改善5年生存率和无瘤生存率。
Objective To investigate the effect of preoperative radiotherapy and chemotherapy in locally advanced low rectal cancer and compare the long-term efficacy of anterior resection and Miles surgery. Methods 103 patients with rectal cancer were divided into preoperative chemoradiotherapy + anterior resection group (group A, n = 53) and Miles surgery group (group B, n = 50). The primary tumor from the anus of the median distance 6.2cm. There were 22 cases in stage Ⅱ and 81 cases in stage Ⅲ (TNM, UICC). Radiotherapy using linear accelerator pelvic 3 ~ 4 field irradiation dose 35 ~ 45Gy, 4 ~ 5 weeks to complete. Chemotherapy with fluorouracil-based chemotherapy. Results The 5-year survival rates of A and B groups were 64.2% and 43.7%, respectively (P <0.05). The 5-year disease-free survival rates were 52.8% and 31.6%, respectively. The local recurrence rates were 15.2% and 19.3 % (P> 0.05). The distant metastasis rates were 25.5% and 48.5% respectively (including local recurrence and distant metastasis) (P <0.05). A group of postoperative pathology complete remission rate was 13.2%. Follow-up rate was 88.3%. Conclusion Preoperative radiotherapy and chemotherapy combined with anterior resection for the treatment of locally advanced low rectal cancer not only protect the anus, but also improve the 5-year survival rate and tumor-free survival rate.