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目的 探讨术前放化疗对低位直肠癌的治疗价值。方法 对 12例难以保肛的进展期低位直肠癌进行术前放化疗 ,基本方案为 5 FU( 75 0mg/m2 ) ,四氢叶酸 ( 2 0mg/m2 )和CPT 11( 75mg/m2 )每周一次 ,配合高能X线对盆腔野和直肠野作总剂量为 2 5～ 30Gy的放疗。新辅助治疗完成后 7～ 10天进行手术。 结果 放化疗后直肠癌灶平均直径由 5 48cm降低到 2 75cm ,距肛缘距离平均增加 1 0cm。对直肠癌下缘连续切片 ,癌向直肠远端浸润的距离均小于 0 2cm。 1例病人通过全系膜切除保留了肛门 ,8例病人通过切除部分齿状线的方式保留了肛门。 3例病人采用了Miles术 ,其中 1例为后盆脏切除。结论 应用术前放化疗 ,可以使低位进展期直肠癌缩小 ,分期降低 ,减小肿瘤浸润深度和远端浸润距离 ,提高保肛的可能性。病人对本方案的耐受性较好。
Objective To investigate the value of preoperative radiotherapy and chemotherapy for treatment of low rectal cancer. Methods Preoperative chemoradiotherapy was performed on 12 cases of advanced low rectal cancer refractory to anal sphincter preservation. The basic regimens were 5 FU (75 0 mg / m 2), tetrahydrofolate (20 mg / m 2) and CPT 11 (75 mg / m 2) Once, with high-energy X-ray pelvic field and rectal field total dose of 25 ~ 30Gy of radiotherapy. Neoadjuvant treatment is completed 7 to 10 days after surgery. Results The average diameter of rectal cancer after radiotherapy and chemotherapy decreased from 5 48cm to 2 75cm, anomaly margin from the average increase of 10cm. On the lower edge of rectal cancer continuous section, the distance of cancer to distal rectal infiltration were less than 0 2cm. One patient retained the anus through total mesorectal excision, and eight patients retained the anus by excising some of the dentate line. Three patients underwent Miles surgery, of which 1 was pelvic excision. Conclusion Preoperative chemoradiotherapy can reduce the low-grade advanced colorectal cancer, stage reduction, reduce the depth of tumor invasion and distal infiltration distance, improve the possibility of anal sphincter preservation. The patient’s tolerance to the program is better.