从微血管密度改变分析术前放化疗对中低位直肠癌的临床疗效.doc

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1、从微血管密度改变分析术前放化疗对中低位直肠癌的临床疗效作者：王永兵张根福缪旭东黄胜王高仁【摘要】目的结合微血管密度(MVD)改变，评价术前放化疗对中低位直肠癌中的临床疗效。方法80例腔内超声为T3、T4期的中低位直肠癌患者随机分为两组：对照组40例直接手术治疗;研究组40例先予放疗35〜48Gy+同步FOLFOX4方案化疗2次，放疗结束后4~6周行手术治疗，术后两组均予FOLFOX4方案化疗，比较两组病理改变及血管生长因子(VEGF)及MVD表达，手术并发症和疗效随访。结果与对照组相比，研究组放化疗后肿瘤缩小，分期降低，手术切除率(96%vs82.5%)和保肛率(85%vs60%)明显提

2、高，手术并发症相仿，病理VEGF及MVD表达明显下调，3年随访局部复发率仅为7.5%。结论术前放化疗可以改变T3、T4期中低位直肠癌的微血管密度(MVD),进而改善手术疗效，并不增加手术难度和并发症的发生，是一种较好的综合治疗手段。【关键词】直肠癌；术前放化疗；微血管密度；局部复发[Abstract]ObjectiveToestimatetheeffectsofpreoperativechemoradiotherapyonthetreatmentofmidandlowrectalcancer.MethodsEightycases,whichwereexaminedpreoperative

3、lybytransrectaldopplerultrasonographytobewithmidandlowrectalcancers(TNMstageIIIandIV),wereenrolledinthisstudyanddividedrandomlyintothecontrolgroupandthetreatmentgroup.Fortycasesincontrolgroupwereoperateddirectlywithoutpreoperationchemoraditherapy.Theother40casesintreatmentgroupwerefirstlytreatedt

4、wicewith48Gray)combinedwithpreoperativeradiotherapy(35chemotherapy(oxaliplatincombinedwith5fluorouraci1andleucovorincalcium,F0LF0X4)andwereoperated4to6weekslater.Al180casesweretreatedwithchemotherapy(F0LF0X4)afteroperation.Thepathologicchanges,expressionofvascularendothelialgrowthfactor(VEGF)andm

5、icrovesselupresultsofthetwodensity(MVD),complicationsandfollowgroupswerecompared.ResultsThetumorvolumereducedanditsTstagedegradedinthetreatmentgroupcomparedwiththoseinthecontrolgroup.Theresectionrate(96%vs82.5%)andthesphincterpreservingrate(85%vs60%)increasedinthetreatmentgroupcomparedwiththosein

6、thecontrolgroup.ThepositiveexpressionrateofVEGFandMVDsignificantlydecreasedinthetreatmentgroup.Therewasnotsignificantdifferenceintheincideneeofpostoperativecomplicationsbetweenthe2groups.Thelocal3yearrecurrenceratewasonly7.5%inthetreatmentgroupduring.ConclusionPreoperativechemoradiotherapycanchan

7、gethepositiveexpressionrateofMVDinthemidandlowrectalcancer(TNMstageIIIandIV)withoutincreasingthedifficultyofoperationandtheincideneeofpostoperativecomplications.Soitmaybeabetterandeffectivetreatmentforthemidandlowrecta