多学科联合腹腔镜手术治疗老年直肠癌的特点及效果
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摘要
目的分析多学科协作联合腹腔镜手术治疗老年直肠癌的特点及效果。方法选取100例老年直肠癌患者,随机分为观察组与对照组。对照组采用新辅助化疗联合腹腔镜手术治疗,观察组在对照组的基础上加入辅助化疗,比较两组患者的临床疗效、术后并发症发生率及术后拔除胃管、尿管、引流管的时间,并采用问卷调查分析患者对治疗的满意度。结果观察组与对照组的临床疗效显著优于对照组(P <0.01);观察组并发症发生率为10.0%,对照组并发症发生率为22.0%,两组间比较差异有统计学意义(P <0.01);观察组术后拔除胃管、尿管、引流管的时间均显著短于对照组(P <0.01),且观察组患者的满意率也显著优于对照组(P <0.01)。结论多学科协作模式下,新辅助化疗、辅助化疗联合腹腔镜手术在老年直肠癌患者中具有较高的应用价值,能够缩短提高临床疗效以及患者的满意度,改善老年患者的生活质量。
Objective To analyze the characteristics and effects of multidisciplinary collaboration combined with laparoscopic surgery in the treatment of rectal cancer.Methods From January 2012 to December 2016,100 elderly patients with rectal cancer were randomly divided into observation group and control group.The patients in the control group were treated with neoadjuvant chemotherapy combined with laparoscopic surgery.The observation group was treated with adjuvant chemotherapy on the basis of the control group.The clinical curative effects,postoperative complication rates and postoperative removal of gastric tube,ureter,drainage tube,patient satisfactions with treatment by questionnaires were analyzed.Results The clinical curative effect of the observation group and the control group was significantly better than that of the control group( P < 0.01).The complication rate was 10.0% in the observation group and 22.0% in the control group.The difference between the two groups was statistically significant( P < 0.01).The rate of removal of gastric tube,ureter and drainage tube in the observation group was significantly shorter than that in the control group( P < 0.01),and the satisfaction rate of the observation group was also significantly better than that of the control group( P < 0.01).Conclusion Neoadjuvant chemotherapy,adjuvant chemotherapy combined with laparoscopic surgery has a high value in elderly patients with rectal cancer.It can shorten the improvement of clinical curative effect and patient satisfaction and improve the quality of life of elderly patients.
Objective To analyze the characteristics and effects of multidisciplinary collaboration combined with laparoscopic surgery in the treatment of rectal cancer.Methods From January 2012 to December 2016,100 elderly patients with rectal cancer were randomly divided into observation group and control group.The patients in the control group were treated with neoadjuvant chemotherapy combined with laparoscopic surgery.The observation group was treated with adjuvant chemotherapy on the basis of the control group.The clinical curative effects,postoperative complication rates and postoperative removal of gastric tube,ureter,drainage tube,patient satisfactions with treatment by questionnaires were analyzed.Results The clinical curative effect of the observation group and the control group was significantly better than that of the control group( P < 0.01).The complication rate was 10.0% in the observation group and 22.0% in the control group.The difference between the two groups was statistically significant( P < 0.01).The rate of removal of gastric tube,ureter and drainage tube in the observation group was significantly shorter than that in the control group( P < 0.01),and the satisfaction rate of the observation group was also significantly better than that of the control group( P < 0.01).Conclusion Neoadjuvant chemotherapy,adjuvant chemotherapy combined with laparoscopic surgery has a high value in elderly patients with rectal cancer.It can shorten the improvement of clinical curative effect and patient satisfaction and improve the quality of life of elderly patients.
引文
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[10]Torkzad MR,Suzuki C,Tanaka S,et al.Morphological assessment of the interface between tumor and neighboring tissues,by magnetic resonance imaging,before and after radiotherapy in patients with locally advanced rectal cancer[J].Acta Radiologica,2015,49(10):1099-1103.
[11]Erben P,Horisberger K,Muessle B,et al.mRNA expression of platelet-derived growth factor receptor-beta and C-KIT:correlation with pathologic response to cetuximab-based chemoradiotherapy in patients with rectal cancer[J].Biosci Rep,2015,72(5):1544-1550.
[12]Konski A,Li T,Sigurdson E,et al.Use of molecular imaging to predict clinical outcome in patients with rectal cancer after preoperative chemotherapy and radiation[J].Biosci Rep,2015,74(1):55-59.
[13]Herman MP,Kopetz S,Bhosale PR,et al.Sacral insufficiency fractures after preoperative chemoradiation for rectal cancer:incidence,risk factors,and clinical course[J].Biosci Rep,2015,74(3):818-823.
[14]Kalff V,Ware R,Heriot A,et al.Radiation changes do not interfere with postchemoradiation restaging of patients with rectal cancer by FDG PET/CT before curative surgical therapy[J].Biosci Rep,2014,74(1):60-66.
[15]Akimoto T,Katoh H,Kitamoto Y,et al.Rectal bleeding after high-dose-rate brachytherapy combined with hypofractionated external-beam radiotherapy for localized prostate cancer:impact of rectal dose in high-dose-rate brachytherapy on occurrence of grade 2 or worse rectal bleeding[J].Biosci Rep,2016,65(2):364-370.
[2]李霆,孟翔凌,张震,等.腹腔镜直肠癌D3淋巴结清扫联合盆底自主神经保留术的疗效及安全性[J].中华实验外科杂志,2015,32(4):721-723.
[3]张成余.老年直肠癌患者行腹腔镜与开腹直肠癌根治术的近远期疗效对比[J].山东医药,2015,51(43):92-93.
[4]谢波,钱军,喻大军,等.腹腔镜与开腹直肠癌手术对围手术期患者应激和免疫功能的影响[J].广东医学,2016,37(20):3068-3070.
[5]张逖,张建都,王泰岳,等.腹腔镜下直肠癌前侧切除术治疗直肠癌156例疗效观察[J].山东医药,2013,53(23):81-82.
[6]李丹,庄競,刘永刚,等.老年直肠癌患者腹腔镜全直肠系膜切除术后吻合口瘘的相关因素[J].中国老年学杂志,2015,34(15):4302-4304.
[7]王旻,陈学博,王爽,等.比较腹腔镜与开腹直肠癌扩大根治术对老年患者细胞免疫功能的影响[J].中国老年学杂志,2015,31(6):922-924.
[8]姜润学,蔡海峰,胡万宁,等.纳米炭在腹腔镜下进展期直肠癌根治术中的应用[J].中国肿瘤临床,2013,32(18):1123-1126.
[9]孙延东,吴国豪,张波,等.腹腔镜与开腹手术治疗直肠癌的临床对照研究[J].中华胃肠外科杂志,2014,34(4):369-372.
[10]Torkzad MR,Suzuki C,Tanaka S,et al.Morphological assessment of the interface between tumor and neighboring tissues,by magnetic resonance imaging,before and after radiotherapy in patients with locally advanced rectal cancer[J].Acta Radiologica,2015,49(10):1099-1103.
[11]Erben P,Horisberger K,Muessle B,et al.mRNA expression of platelet-derived growth factor receptor-beta and C-KIT:correlation with pathologic response to cetuximab-based chemoradiotherapy in patients with rectal cancer[J].Biosci Rep,2015,72(5):1544-1550.
[12]Konski A,Li T,Sigurdson E,et al.Use of molecular imaging to predict clinical outcome in patients with rectal cancer after preoperative chemotherapy and radiation[J].Biosci Rep,2015,74(1):55-59.
[13]Herman MP,Kopetz S,Bhosale PR,et al.Sacral insufficiency fractures after preoperative chemoradiation for rectal cancer:incidence,risk factors,and clinical course[J].Biosci Rep,2015,74(3):818-823.
[14]Kalff V,Ware R,Heriot A,et al.Radiation changes do not interfere with postchemoradiation restaging of patients with rectal cancer by FDG PET/CT before curative surgical therapy[J].Biosci Rep,2014,74(1):60-66.
[15]Akimoto T,Katoh H,Kitamoto Y,et al.Rectal bleeding after high-dose-rate brachytherapy combined with hypofractionated external-beam radiotherapy for localized prostate cancer:impact of rectal dose in high-dose-rate brachytherapy on occurrence of grade 2 or worse rectal bleeding[J].Biosci Rep,2016,65(2):364-370.