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自1996年9月至1997年5月,对4例低位直肠癌患者采用“1+3”方法,即术前放疗一保肛手术一即刻后装放疗一术后放疗治疗方案。结果:术前放疗后肿瘤体积均有明显缩小,质地硬化:淋巴结转移最多2/10,最少0/8;放疗期间,仅1例出现恶心、呕吐、腹泻等胃肠道反应。术后患者恢复良好,未见伤口延迟愈合、感染,吻合口瘘等并发症。我们认为:①术前放疗可减轻肿瘤对周围组织的侵润,使肿瘤体积有一定程度缩小,从而增加根治性手术切除率,②术毕后装放疗,具有定位准确,对周围组织损伤小等优点,可有效杀灭残存的癌灶和亚临床病灶;③术后放疗由于剂量较大和定位欠准而并发症较多,后装照射的实施可减低术后放疗的剂量,减少放射治疗后的并发症;④暂时性横结肠造口,可避免患者术后由于便次增多而推迟术后放疗的实施。早期进行术后放疗,由于与术毕后装放疗的间隔时间较短,因此可降低照射剂量而减少并发症的出现率;⑤本方案未观察到放疗常见的不良反应;⑥由于放疗可有效地减低术后患者的局部复发率,因此我们认为此方案对术后生存率的改善有一定的意义。
From September 1996 to May 1997, 4 patients with low rectal cancer were treated with the “1+3” method, which included preoperative radiotherapy and anal-preserving surgery immediately after radiotherapy and postoperative radiotherapy. RESULTS: Before surgery, the tumor volume was significantly reduced, texture hardening: lymph node metastasis was at most 2/10, at least 0/8; during radiotherapy, only 1 case had nausea, vomiting, diarrhea and other gastrointestinal reactions. Postoperative patients recovered well and no complications such as delayed wound healing, infection, and anastomotic leakage were observed. We believe that: 1 preoperative radiotherapy can reduce the tumor invasion of the surrounding tissue, so that the tumor volume has been reduced to a certain extent, thereby increasing the rate of radical surgical resection, 2 postoperative radiotherapy installed, with accurate positioning, small damage to the surrounding tissue Advantages, can effectively kill the remaining cancer foci and subclinical lesions; 3 postoperative radiotherapy due to the larger dose and poor positioning and more complications, the implementation of post-installed irradiation can reduce the dose of postoperative radiotherapy, reduce the radiation after treatment Complications; 4 temporary transverse colostomy, to avoid postoperative patients due to the increase in the number of postponed postoperative radiotherapy implementation. Early postoperative radiotherapy, because of the short interval between radiotherapy and postoperative radiotherapy, can reduce the radiation dose and reduce the incidence of complications; 5 this program did not observe the common adverse reactions of radiotherapy; 6 due to radiotherapy can effectively Reduce the local recurrence rate of postoperative patients, so we think this program has a certain significance for the improvement of postoperative survival rate.