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[目的]探讨新辅助治疗应用于老年进展期直肠癌的临床意义,并对其临床价值进行评估。[方法]61例老年进展期直肠癌患者,分为研究组33例,接受新辅助治疗后进行手术治疗,对照组28例,直接进行手术治疗。主要观察指标为两组患者的肿瘤切除率、根治性切除率、保肛率、病理学变化、术后并发症情况、随访局部复发率、远处转移率。[结果]研究组肿瘤根治性切除率和保肛率分别为96.97%(32/33)和90.91%(30/33),明显高于对照组78.57%(22/28)和78.57%(22/28),差异均具有统计学意义(P<0.05);研究组局部复发率和远处转移率分别为9.09%(3/33)和21.21%(7/33),明显低于对照组17.86%(5/28)和39.29%(11/28),差异均具有统计学意义(P<0.05);研究组术后肿瘤退化分级TRG3为24.24%(8/33),明显低于对照组39.29%(11/28),差异均具有统计学意义(P<0.05);两组术后吻合口瘘、切口裂开、切口愈合不良、肠黏连等并发症结果比较,差异无统计学意义(P>0.05)。[结论]新辅助治疗后再手术可以提高老年进展期直肠癌手术切除率,减少直肠癌的转移和复发,改善患者的预后。
[Objective] To explore the clinical significance of neo-adjuvant therapy in elderly patients with advanced colorectal cancer and to evaluate its clinical value. [Method] Sixty-one elderly patients with advanced colorectal cancer were divided into study group (n = 33) and neoadjuvant therapy (n = 28). Surgical treatment was given in 28 cases in control group. MAIN OUTCOME MEASURES: Tumor resection rate, radical resection rate, anal sphincter preservation rate, pathological changes, postoperative complications, follow-up local recurrence rate and distant metastasis rate in two groups of patients. [Results] The radical resection rate and anal sphincter preservation rate were 96.97% (32/33) and 90.91% (30/33) in the study group, which were significantly higher than those in the control group (78.57%, 22/28) and 78.57% (P <0.05). The local recurrence rate and distant metastasis rate in the study group were 9.09% (3/33) and 21.21% (7/33), respectively, which were significantly lower than those in the control group (17.86% (5/28) and 39.29% (11/28) respectively, the difference was statistically significant (P <0.05). The postoperative tumor regression grade TRG3 was 24.24% (8/33) in the study group, which was significantly lower than that in the control group (39.29% (P <0.05). There was no significant difference in complication between two groups (P> 0.05). There was no significant difference between the two groups in postoperative anastomotic fistula, incision fissure, incision healing, intestinal adhesion and other complications > 0.05). [Conclusion] Reoperation after neoadjuvant therapy can improve the surgical resection rate of rectal cancer in elderly patients, reduce the metastasis and recurrence of rectal cancer, and improve the prognosis of patients.