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材料与方法:病人分为二组,研究组43例,用于确定直肠癌术前放化疗的效果.活检证实均为直肠腺癌无盆腔外转移.经CT和乙状肠镜证实癌侵及肠壁全层.无腹部手术及放、化疗史.病灶中位直径<3cm,术后未再治疗.对照组为同单位1978～1993年回顾性资料56例,临床资料与研究组相似,术后经化疗或外照射治疗.术前放、化疗:放疗用光子射线或直线加速器,三野或四野,每周5次各180cGY,共25次总剂量45GY.化疗自首次放疗5天内开始,每日5-FU500mg/m~2快速静脉滴注,半小时后给顺铂20mg/m~2,连续5天.放疗最后一周重复上述化疗.每治疗前给甲哌氯丙嗪10mg、地塞米松10mg、苯海拉明50mg、胃复安2mg/kg.完成治疗2～4周后经乙状结肠镜观察治疗反应,活检无肿瘤为完全缓解、肿瘤减少>50%为部分缓解.化疗结束3～4周手术.结果:大部分病人能耐受洽疗,最常见的副作用是腹泻(97%),5例因中度腹泻需减少5-FU用量,2例因严重腹泻中断治疗2周,1例末完成术前计划.1例因严重膀胱炎暂停治疗1周,1例放疗后发生放射性神经炎.6例见血液毒性,因贫血需输血但未中断治疗.放、化疗后乙状结肠镜检查所有肿瘤均缩小,22例临床完全缓解.34例行腹会阴切除术、5例低位前切除术、2例经肛门局部广泛切除术,2例因完全缓解拒绝手术.病理检查11例镜下无瘤,9例仅见?
Materials and Methods: The patients were divided into two groups, the study group was 43 cases, used to determine the effect of preoperative radiotherapy and chemotherapy for rectal cancer. Biopsy confirmed that there were no extrapelvic extravasation of rectal adenocarcinoma. CT and sigmoidoscopy confirmed the invasion of cancer. Intestinal wall full layer. Abdominal surgery and radiotherapy and chemotherapy history. The median lesion diameter <3cm, no retreatment after surgery. The control group for the same unit from 1978 to 1993 retrospective data in 56 cases, clinical data and research group similar surgery After chemotherapy or external radiation therapy. Preoperative radiotherapy and chemotherapy: Photon ray or linear accelerator for radiotherapy, Sanye or Seno, 180 cGY for 5 times per week for a total of 25 doses of 45 GY. Chemotherapy started within 5 days after the first radiotherapy. 5-FU 500mg/m~2 rapid intravenous infusion, half an hour later to cisplatin 20mg/m~2 for 5 consecutive days. The above chemotherapy was repeated in the last week of radiotherapy. Before each treatment, mepprochlorazine 10mg, dexamethasone 10mg , Diphenhydramine 50mg, Metoclopramide 2mg/kg. After 2 to 4 weeks of treatment, the response to treatment was observed by sigmoidoscopy. No biopsy was complete remission, tumor reduction >50% was partial remission. The end of chemotherapy was 3 to 4 weeks. Surgery. Results: Most patients can tolerate the treatment, the most common side effect is diarrhea (97%), 5 cases need to be reduced due to moderate diarrhea. Less 5-FU dose, 2 cases interrupted treatment for 2 weeks due to severe diarrhea, 1 case completed the preoperative plan, 1 case was suspended for 1 week due to severe cystitis, 1 case had radiation neuritis after radiotherapy, 6 cases see hematological toxicity, Anemia required blood transfusion but did not interrupt treatment. After sigmoidoscopy for radiotherapy and chemotherapy, all tumors were reduced and 22 cases had complete clinical remission. 34 patients underwent abdominal perineal resection, 5 patients underwent low anterior resection, and 2 patients underwent extensive local anal resection. 2 cases refused surgery due to complete remission. Pathological examination of 11 cases of tumor-free, 9 cases only see?