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目的:分析直肠癌的临床病理变化特征,对术前放疗和联合放疗、化疗的疗效进行评价。方法:146例直肠癌患者分为术前放疗组(组1)31例,放、化疗组(组2)115例。放疗总剂量为45 Gy,每周5次,每次1.8 Gy。全身化疗共2个疗程,四氢叶酸静脉滴入,随后静脉给予5-氟尿嘧啶。辅助治疗完成后4～6周采取手术治疗。结果:治疗中出现的并发症,除了组2的皮肤红斑症较多以外,其它并发症无显著差异。术后并发症最多的是切口延迟愈合,其次为肠梗阻,两组患者术后并发症没有显著差异。腔内B超和CT显示肿瘤大小的减少在组1为45.1%,组2为75.6%。术后病理显示,淋巴结减少在两组中均有明显效果。总复发率在组1为35.4%,组2为20%,且两组患者都表现出远处转移的发生率比局部复发率高。结论:术前放、化疗与单独放疗相比较,治疗中和术后并发症无显著差异;而病理学治疗效果,前者明显优于后者。
Objective: To analyze the clinical and pathological features of rectal cancer and evaluate the efficacy of preoperative radiotherapy and radiotherapy and chemotherapy. Methods: A total of 146 patients with rectal cancer were divided into preoperative radiotherapy group (group 1), 31 patients and radiotherapy and chemotherapy group (group 2), 115 patients. The total dose of radiation is 45 Gy, 5 times a week for 1.8 Gy each. A total of 2 courses of systemic chemotherapy, intravenous tetrahydrofolate drop, followed by intravenous 5-fluorouracil. 4 to 6 weeks after the completion of adjuvant treatment surgery. Results: There was no significant difference in complication between treatments except for the more skin erythema in group 2. Postoperative complications were delayed incision healing, followed by intestinal obstruction, postoperative complications in both groups no significant difference. Endoptic B-ultrasound and CT showed a decrease in tumor size of 45.1% in group 1 and 75.6% in group 2. Postoperative pathology showed that lymph node reduction in both groups have significant effect. The overall recurrence rate was 35.4% in group 1 and 20% in group 2, and both groups showed a higher incidence of distant metastases than local recurrence. Conclusion: Preoperative radiotherapy and chemotherapy compared with radiotherapy alone, no significant difference in the treatment of postoperative complications; and pathological treatment, the former was significantly better than the latter.