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目的:总结直肠癌多学科综合治疗的最新进展,并对存在的问题和发展前景进行分析。方法:应用计算机检索Medline及CHKD期刊全文数据库检索系统,以“直肠癌/外科手术/化疗,放疗/分析”为关键词,检索2000年1月～2008年12月有关直肠癌多学科综合治疗及其价值方面的文献。精选30篇文献,最后纳入分析26篇。结果:准确的分期是直肠癌多学科综合治疗的关键,新辅助治疗结合根治性手术的模式是降低局部复发率、延长生存时间的有效手段,尤其在提高保肛率方面更具优势。根治性手术结合辅助治疗仍被公认为Ⅱ～Ⅲ期直肠癌的标准治疗模式。把握转移瘤可切除标准和时机结合辅助治疗可延长生存时间。化学新药和靶向药物及新联合治疗方案的引入,可提高直肠癌的疗效。结论:应积极倡导直肠癌规范化多学科综合治疗,与结肠癌相比,直肠癌多学科综合治疗改善总生存率的循证医学证据尚不充分,需深入研究。
Objective: To summarize the latest progress of multidisciplinary treatment of rectal cancer, and to analyze the existing problems and development prospects. Methods: The computer-based retrieval system of Medline and CHKD periodicals full-text database was searched. The key words of “rectal cancer / surgery / chemotherapy, radiotherapy / analysis” were retrieved from January 2000 to December 2008. Treatment and its value literature. Selected 30 articles, finally included in the analysis of 26 articles. Results: Accurate staging is the key to comprehensive multidisciplinary treatment of rectal cancer. Neoadjuvant therapy combined with radical operation mode is an effective way to reduce the local recurrence rate and prolong the survival time, especially in improving the anal sphincter preservation rate. Radical surgery combined with adjuvant therapy is still recognized as the standard treatment of rectal cancer Ⅱ ~ Ⅲ mode. Grasp metastases resectable criteria and timing combined with adjuvant therapy can extend the survival time. The introduction of new chemical drugs and targeted drugs and a new combination of treatment programs can improve the efficacy of rectal cancer. Conclusion: The standardized and multidisciplinary treatment of rectal cancer should be actively advocated. Evidence-based medical evidence of improving the overall survival rate of multi-disciplinary treatment of rectal cancer is not sufficient compared with that of colon cancer, and further study is needed.