目的 通過多學(xué)科協(xié)作(MDT)診治模式下新輔助化療的運用，探討其對直腸癌手術(shù)過程和結(jié)果的影響。方法 回顧性分析2007年6月~9月期間四川大學(xué)華西醫(yī)院普外三科施行MDT模式和非MDT模式治療的直腸癌患者的臨床資料，分析術(shù)中發(fā)現(xiàn)的病理學(xué)改變、組織學(xué)改變以及手術(shù)結(jié)果指標(biāo)的差異。結(jié)果 在病理學(xué)改變的評價指標(biāo)中，MDT組中腹腔粘連發(fā)生率（13.5%,7/52）、腹腔積液發(fā)生率（7.7%,4/52）和潛在性癌性腸梗阻發(fā)生率（5.8%, 3/52）均明顯低于非MDT組（P=0.000）。在組織學(xué)改變的評價指標(biāo)中，MDT組中腸系膜組織的質(zhì)地較非MDT組更易碎和出血（P=0.000）； MDT組中發(fā)現(xiàn)盆腔組織的水腫發(fā)生率較非MDT組更高（P=0.000）,但盆底腹膜的充血、水腫和直腸系膜的粘連/固定的發(fā)生率2組間的差異無統(tǒng)計學(xué)意義（P gt;0.05）。在手術(shù)結(jié)果指標(biāo)中，MDT組的手術(shù)時間短于非MDT組，術(shù)中出血量也少于非MDT組（P=0.000），且MDT組在術(shù)中行盆腔植物神經(jīng)保護的效果也好于非MDT組（P=0.000）。MDT組和非MDT組對施行直腸癌根治保肛手術(shù)術(shù)前判斷的準(zhǔn)確度均較高（92.3% vs 76.2%）。結(jié)論 新輔助化療對直腸癌手術(shù)的難度有一定的影響，但通過更為規(guī)范和準(zhǔn)確的手術(shù)操作可保證手術(shù)的順利施行。優(yōu)化MDT模式下的綜合治療方案并建立綜合的新輔助化療效果的術(shù)前評估體系，將成為下一步需要探索的課題。
引用本文： 汪曉東,李亞倫,邱萌,羅德云,李立. 多學(xué)科協(xié)作診治模式下新輔助化療對直腸癌手術(shù)的影響. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(2): 136-139. doi: 復(fù)制
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- 1. <><><><><><> [1]汪曉東,曹霖,羅德云,等.多學(xué)科協(xié)作診治模式下運行結(jié)直腸癌綜合治療的臨床對照研究[J].中國普外基礎(chǔ)與臨床雜志,2008; 15(1):63.
- 2. Church JM,Gibbs P,Chao MW,et al.Optimizing the outcome for patients with rectal cancer[J].Dis Colon Rectum,2003; 46(3):389.
- 3. Czito BG,Willett CG,Bendell JC.Combined-modality therapy for rectal cancer:future prospects[J].Clin Colorectal Cancer,2007; 6(9):625.
- 4. Sanghera P,Ho K,Muscroft T,et al.Neoadjuvant chemotherapy enables R0 resection of locally advanced rectal cancer in a patient with a previously irradiated pelvis[J].Br J Radiol,2007; 80(956):e170.
- 5. Rezvani M,Franko J,Fassler SA,et al.Outcomes in patients treated by laparoscopic resection of rectal carcinoma after neoadjuvant therapy for rectal cancer[J].JSLS,2007; 11(2):204.
- 6. Niederbuber JE.Neoadjuvant therapy[J].Ann Surg,2003; 229(3):303.
- 7. Theodoropoulos G,Wise WE,Padmanabhan A,et al.T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival[J].Dis Colon Rectum,2002; 45(7):895.
- 8. 李立.結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新(一)～(十二)[J].中國普外基礎(chǔ)與臨床雜志,2006～2007; 13(1～6):106,222,336,461,597,719; 14(1～6):96,216,350,481,592,716.
- 9. De Paoli A,Innocente R,Buonadonna A,et al.Neoadjuvant therapy of rectal cancer new treatment perspectives[J].Tumori,2004; 90(4):373.