【摘要】 目的探讨Ⅱ~Ⅲ期直肠癌经腹会阴联合切除术(Miles术)腹膜外聚酯补片植入对放射性小肠损伤的预防作用。方法选取2009-01-01-2011-10-31临沂市肿瘤医院收治的低位直肠癌行Miles术患者144例,分为研究组和对照组各72例。研究组手术中采用盆底腹膜外植入大小适合的聚酯补片修复盆底腹膜+术后调强放射治疗;对照组采用手术中常规关闭盆底腹膜+术后调强放射治疗。比较两组放疗计划中小肠的受照体积剂量及急慢性放射性肠损伤发生情况。结果研究组放疗计划中小肠的受照体积剂量V20、V40和V50(V20、V40和V50分别表示接受20、40和50Gy照射体积占总体积的百分比)分别为(12.72±9.51)%、(11.09±7.94)%和(3.13±3.10)%,对照组分别为(23.15±16.09)%、(12.37±9.79)%和(5.11±4.24)%,研究组明显低于对照组,差异有统计学意义,P<0.001。研究组和对照组急性肠损伤发生率分别为51.4%和73.6%,差异有统计学意义,χ2=12.352,P<0.001;慢性肠损伤发生率分别为6.9%和22.2%,差异有统计学意义,χ2=-2.560,P=0.010。结论直肠癌Miles术中应用腹膜外补片植入是降低低位直肠癌术后急慢性放射性肠损伤的有效方法。更多还原

【Abstract】 OBJECTIVE To disscuss preventive effect of intestinal irradiation injury with extraperitoneal patch implantation during Miles operation of StageⅡandⅢrectal carcinoma.METHODS Totally 144 patients of stageⅡandⅢrectal carcinoma who would received Miles operation were divided into two groups,study group and control group.72 patients in study group whose pelvic peritoneal were repaired with proper polyester mesh received intensity modulated radiation therapy while the other 72 patients in control group got conventional closed pelvic peritoneal during operation and then received intensity modulated radiation therapy.The small intestine irradiated volume and acute or chronic intestinal injury of these two group were compared.RESULTS The small intestine irradiated volume of V20,V40 and V50 were respectively(12.72±9.51)%,(11.09±7.94)%,(3.13±3.10)% in study group,and(23.15±16.09)%,(12.37±9.79)%,(5.11±4.24)%in control group.The volume of study group was obviously lower than those of control group,and there was statistical significance(P<0.001).The incidence rate of acute intestinal injury was respectively 51.4% and73.6%in study group and control group,and there was statistical significance(χ2=12.352,P<0.001).The incidence rate of chronic intestinal injury was 6.9% and 22.2%in study group and control group,and there was statistical significance(χ2=-2.560,P=0.010).CONCLUSION Extraperitoneal patch implantation during Miles operation of Stage ⅡandⅢrectal carcinoma is an effective measure to prevent acute or chronic intestinal injury and it is worth clinical popularization and application.更多还原