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1、低位局部进展期直肠癌治疗中新辅助同步放化疗联合TME术的价值探究摘要：目的全直肠系膜切除(totalmesorectalexcision,TME)是目前直肠癌手术治疗的标准方法，但由于其复杂的结构，局部病灶清除不完全致使切除率降低，术后复发风险高。本文探讨新辅助同步放化疗联合TME术治疗对中低位局部进展期直肠癌的有效性和安全性。方法选取本院2011年6月〜2013年12月收治的60例中低位局部进展期直肠癌患者,包括28例II期(T3-4T0M0),32例HI期(T1-4N1-2M0)。所有患者均接受术前新辅助
2、放化疗(放疗总剂量盆腔区为40〜46Gy,瘤床区为50—56Gy,1.8Gy/次，5次/w,同步化疗采用FOLFOX4方案，行2个周期)。新辅助同步放化疗结束4〜6w后根据TME原则行手术治疗。结果60例患者均完成新辅助放化疗，放化疗期间1〜2级不良反应发生率为70.0%,3级不良反应发生率为10.0%,无4级不良反应发生。患者临床TNM分期下降。新辅助放化疗结束后4〜6w,60例患者行根治性手术治疗，其中38例行低位或超低位前切除术(Dixon术)，22例行腹会阴联合切除术(Miles术),保肛率75.0%
3、(45/60)o无1例发生围手术期死亡，术后并发生症的总发生率为13.3%(8/60)o结论新辅助同步放化疗联合TME对治疗中低位局部进展期直肠癌有效并安全，其可以降低肿瘤分期、复发率，提高保肛率。关键词：肠癌；新辅助疗法；同步放化疗；TME术Abstract:ObjectiveTME(totalmesorectalexcision,TME)iscurrentlythestandardmethodofsurgicaltreatmentforcolorectalcancer,butbecauseofitscom
4、plexstructure,resultinginpartialdebridementincompleteresectionratedecreased,riskofrecurrenceishigh.Thisresearchistoevaluatetheefficacyandsafetyofneoadjuvantconcurrentchemoradiotherapyincombinationwithtotalmesorectaiexcision(TME)intreatmentoflocallyadvancedm
5、iddleand1owerrectalcancer.Methods60patientswithlocallyadvancedmiddleandlowerrectalcancerinthishospitalsinceJune2011toDecember2013wereseiectedastheobservationgroupinthisstudy,and28patientsofwhomhadstageII(T3-4T0M0),32patientshadstageIII(T1-4N1-2M0).Allpatien
6、tsreceivedneoadjuvantconcurrentchemoradiotherapy(thedoseofpreoperativeradiotherapywas40-50Gy,1.8Gy/time,5timesperweek；concurrentlycombinedwithtwocyclesofcapecitabine-basedregimen).Thesurgicaloperationwasperformed4〜6weeksafterconcurrentchemoradiotherapy.Resu
7、lts60patientscompletedtheneoadjuvantconcurrentchemoradiotherapy.Thetotalrateoflevel1-2adversereactionwas70%,thetotalrateoflevel3adversereactionwas10%,no4adversereaction.Afterradiationandchemotherapy,48cases(80%)ofclinicalTNMstagingweredeclined.60patientswer
8、egivensurgicaloperation,38patientsreceivedlow/ultra-lowanteriorresection(Dixon),22patientsreceivedabdominoperinealresection(Mlies)afterchemoradiotherapyfor4〜6weeks.Thesphincterpreservationratewas75.0%(
