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目的:探讨腹腔镜手术联合术中放疗代替术前放疗治疗进展期直肠癌的的安全性及疗效。方法:回顾性分析上海交通大学医学院附属瑞金医院外科在2012年2月至2013年2月间行腹腔镜手术联合术中放疗的8例进展期直肠癌。本研究所有病人均接受腹腔镜Dixon术,术中运用Mobetron移动式术中放疗加速器照射瘤床,剂量为10~18 Gy,均接受术后随访。结果:本研究病人均顺利完成腹腔镜辅助Dixon术,其中5例行预防性末端回肠造口,平均手术时间(151.2±18.6)(125~180)min,平均术中出血量(112.5±58.2)(50~200)m L,术后中位住院时间为8 d,术后并发腹泻2例、尿潴留及盆腔疼痛各1例,无手术相关死亡病例及吻合口漏等严重并发症。中位随访时间为24个月,随访期间未出现局部复发病例。结论:腹腔镜联合术中放疗治疗局部进展期直肠癌创伤小、恢复快,具有一定的安全性及可行性。
Objective: To investigate the safety and efficacy of laparoscopic surgery combined with intraoperative radiotherapy in the treatment of advanced rectal cancer instead of preoperative radiotherapy. Methods: A retrospective analysis of 8 cases of advanced rectal cancer undergoing laparoscopic surgery with intraoperative radiotherapy from February 2012 to February 2013 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. In this study, all patients underwent laparoscopic Dixon surgery, intraoperative use of Mobetron mobile intraoperative radiation accelerator tumor bed irradiation dose of 10 ~ 18 Gy, were followed up. Results: The patients underwent laparoscopic assisted Dixon successfully. Among them, 5 patients received prophylactic distal ileostomy. The mean operative time was 151.2 ± 18.6 (125-180) min and the average blood loss was 112.5 ± 58.2. (50 ~ 200) m L, postoperative median length of stay was 8 days, postoperative diarrhea in 2 cases, urinary retention and pelvic pain in 1 case. No operative deaths and anastomotic leakage were found. The median follow-up time was 24 months, with no local recurrence during follow-up. Conclusion: Laparoscopy combined with intraoperative radiotherapy in the treatment of locally advanced rectal cancer with less trauma and faster recovery has some safety and feasibility.