【摘要】 目的探讨Ⅱ～Ⅲ期直肠癌患者新辅助放化疗后全直肠系膜切除的手术时机选择及其对外周血循环肿瘤细胞(CTC)的影响。方法回顾性分析82例Ⅱ～Ⅲ期直肠癌患者的临床资料。根据新辅助放化疗后手术时间选择不同,分为常规组(新辅助放化疗后6周内行全直肠系膜切除术)42例和延期组(新辅助放化疗后6～8周行全直肠系膜切除术)40例。比较两组患者的手术相关指标情况(手术时间、术中出血量、术后住院时间)、化疗前后(化疗前和化疗后1、6、8周)外周血CTC测量值变化、术后30天内死亡情况、术后3个月不良反应的发生情况、术后1年病理完全缓解情况及术后3年生存情况。结果两组患者的化疗前外周血CTC测量值、手术时间、术中出血量、术后住院时间、术后30天内的病死率、术后3个月不良反应(吻合口瘘、肺部感染、切口感染、肠梗阻)的发生率、术后3年局部复发率和无进展生存时间比较,差异均无统计学意义(P﹥0.05)。延期组患者化疗后1、6、8周外周血CTC测量值均明显小于常规组,差异均有统计学意义(P﹤0.01);延期组患者术后1年病理完全缓解率高于常规组,差异有统计学意义(P﹤0.05);延期组患者术后3年总生存率低于常规组,差异有统计学意义(P﹤0.05)。结论与新辅助放化疗后6周内接受全直肠系膜切除术比较,Ⅱ～Ⅲ期直肠癌患者新辅助放化疗后6～8周接受全直肠系膜切除术,可有效降低患者外周血CTC测量值,不增加不良反应的发生率,提高病理完全缓解率。更多还原

【Abstract】 Objective To investigate the timing of total mesorectal excision after neoadjuvant chemoradiotherapy for patients with stage Ⅱ-Ⅲ rectal cancer and the effect on circulating tumor cell(CTC) in peripheral blood. Method The clinical data of 82 patients with stage Ⅱ-Ⅲ rectal cancer were analyzed retrospectively, and patients were divided into the routine group(treated by total mesorectal excision within 6 weeks after neoadjuvant chemoradiotherapy, n=42) and the delayed group(treated by total mesorectal excision at 6-8 weeks after neoadjuvant chemoradiotherapy, n=40) according to the timing of total mesorectal excision. The operation related indicators(duration of operation, intraoperative blood loss,postoperative hospitalization time), changes of peripheral blood CTC level before and at 1, 6, 8 week after chemotherapy,mortality within 30 days after operation, the incidences of adverse reactions within 3 month after operation, pathological complete remission rate at 1 year after operation and 3-year survival after operation were compared between the two groups. Result There were no significant differences in peripheral blood CTC level before chemotherapy, duration of operation, intraoperative blood loss, postoperative hospitalization time, mortality within 30 days after operation, the incidences of adverse reactions(including anastomotic impotence, pulmonary infection, incision infection and intestinal obstruction) within 3 month after operation, local recurrence rate at 3 years after operation and progression-free survival time between the two groups(P>0.05). The level of peripheral blood CTC at 1 week, 6 weeks and 8 weeks after chemotherapy in the delayed group were all lower than those in the routine group(P<0.01). The pathological complete remission rate in the delayed group after operation was significantly higher than that in the routine group(P<0.05). The postoperative 3-year total survival rate was significantly lower than that of the routine group(P<0.05). Conclusion Compared to performing total mesorectal excision within 6 weeks after neoadjuvant chemoradiotherapy, perfoming total mesorectal excision at 6-8 weeks can effectively reduce the measured value of peripheral blood CTC without increasing adverse reaction rate, increase pathological complete remission rate of the patients with stage Ⅱ-Ⅲ rectal cancer.更多还原