腹腔镜手术联合术中放射治疗局部进展期直肠癌的回顾性研究

doi:10.16139/j.1007-9610.2021.01.010

摘要/Abstract

摘要：

目的：分析腹腔镜手术联合移动式直线加速器术中放射治疗（intraoperative radiotherapy,IORT）对局部进展期直肠癌（locally advanced rectal cancer,LARC）的疗效。方法：回顾性分析我院2012年1月至2016年1月应用腹腔镜手术联合IORT治疗的22例LARC病人（研究组）。采用配对病例对照设计,在同期开展、同一组医师实施的563例腹腔镜手术治疗的LARC病人中,以年龄、性别、体质量指数、手术方式、肿瘤TNM分期为条件,样本量1∶2进行配对,筛选出44例（对照组）,对两组进行对比分析。结果：研究组手术时间长于对照组（P=0.024）。研究组术后排气时间、恢复流质时间、术后住院时间和术后近期并发症发生率与对照组比较,差异无统计学意义（P>0.05）。研究组与对照组1、3年无局部复发率差异无统计学意义（P=0.742,P=0.533）,1、3年总生存率差异无统计学意义（P=0.476,P=0.447）。结论：与单纯腹腔镜手术相比,腹腔镜手术联合IORT增加手术时间,但其他手术指标差异无统计学意义,因此安全可行,可作为LARC的综合治疗手段之一。

关键词: 术中放射治疗, 局部进展期直肠癌, 并发症, 无局部复发率

Abstract:

Objective To analyze the efficacy of laparoscopic surgery combined with intraoperative radiotherapy (IORT) using mobile linear accelerator in the treatment of patients with locally advanced rectal cancer (LARC). Methods A retrospective analysis was made on 22 patients with LARC as study group who were treated with laparoscopy combined with IORT in our hospital from January 2012 to January 2016. A total of 44 patients were selected as control group using matched case-control design at 1∶2 based on age, sex, body mass index, mode of operation and tumor TNM stage. The patients in two groups were compared and analyzed. Results Average operative time in study group was longer than that in control group (P=0.024). There was no significant difference in postoperative exhaust time, fluid recovery time, postoperative hospital stay and short-term postoperative complications between study group and control group (P>0.05). The diffe-rences in both no local recurrence rate of 1-year (P=0.742) and 3-year (P=0.533) and overall survival rate of 1-year (P=0.476) and 3-year (P=0.447) were not significant between study group and control group. Conclusions Compared with laparoscopic surgery alone for LARC patients, laparoscopic surgery combined with IORT might increase the operative time. However, there was no significant difference in other operative indexes between two groups. Laparoscopic surgery with IORT could be done safe and feasible, and be comprehensive treatments for LARC patients.

Key words: Intraoperative radiotherapy, Locally advanced rectal cancer, Complication, No local recurrence rate

中图分类号:

R735.37

陈献则, 程兮, 赵胜光, 张弢, 施毅卿, 刘坤, 王常刚, 蒋奕玫, 季晓频, 赵任. 腹腔镜手术联合术中放射治疗局部进展期直肠癌的回顾性研究[J]. 外科理论与实践, 2021, 26(01): 48-53.

CHEN Xianze, CHENG Xi, ZHAO Shengguang, ZHANG Tao, SHI Yiqing, LIU Kun, WANG Changgang, JIANG Yimei, JI Xiaopin, ZHAO Ren. Retrospective study on laparoscopic surgery combined with intraoperative radiotherapy in treatment of locally advanced rectal cancer[J]. Journal of Surgery Concepts & Practice, 2021, 26(01): 48-53.

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项目	研究组（n=22）	对照组（n=44）
性别
男	10（45.45）	20（45.45）
女	12（54.55）	24（54.55）
中位年龄（岁）	54（29~71）	53（30~72）
BMI
总体	23.15±3.07	23.26±3.18
男	23.35±3.75	24.03±3.84
女	22.65±2.86	22.58±2.94
ASA分级
Ⅰ	16（72.73）	34（77.27）
Ⅱ	6（27.27）	10（22.73）
肿块距离肛缘（cm）	8.0（6.0~12.0）	7.5（5.0~12.0）
T分期
T₃	9（40.91）	18（40.91）
T₄	13（50.09）	26（50.09）
N分期
N₀	8（36.37）	16（36.37）
N₁	9（40.91）	18（40.91）
N₂	5（22.73）	10（22.73）
M分期
M₀	22	44

项目	研究组（n=22）	对照组（n=44）	P值
手术时间（min）	146.7±32.5	118.2±31.3	0.024
术中出血量（mL）	51.8±42.5	52.6±47.2	0.286
淋巴结清扫（枚）	13.1±2.7	12.8±2.5	0.572
下切缘长度（cm）	2.5±0.5	2.6±0.4	0.325

项目	研究组（n=22）	对照组（n=44）	P值
术后排气（d）	2.3（1.0~4.0）	2.2（1.0~4.0）	0.641
进食流质（d）	4.7（3.0~6.0）	4.5（3.0~6.0）	0.749
术后住院（d）	8.9（7.0~30.0）	9.2（7.0~28.0）	0.548

项目	研究组（n=22）	对照组（n=44）	P值
吻合口漏	2（9.09）	4（9.09）	1
尿潴留	1（4.55）	3（6.82）	0.715
腹泻	2（9.09）	3（6.82）	0.742
盆腔疼痛	2（9.09）	3（6.82）	0.742
小肠梗阻	1（4.55）	1（2.27）	0.612
小肠嵌顿疝	1（4.55）	0	0.154
二次手术	1（4.55）	2（4.55）	1

项目	研究组（n=22）	对照组（n=44）	P值
1年无局部复发率	20（90.91）	41（93.18）	0.742
3年无局部复发率	18（81.82）	33（75.00）	0.533
1年总生存率	22（100）	43（97.73）	0.476
3年总生存率	20（90.91）	37（84.09）	0.447