目的 通過多學科協(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過程和結果的影響。方法 回顧性分析2007年6月~9月期間四川大學華西醫(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，分析術中發(fā)現(xiàn)的病理學改變、組織學改變以及手術結果指標的差異。結果 在病理學改變的評價指標中，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）。在組織學改變的評價指標中，MDT組中腸系膜組織的質地較非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)計學意義（P gt;0.05）。在手術結果指標中，MDT組的手術時間短于非MDT組，術中出血量也少于非MDT組（P=0.000），且MDT組在術中行盆腔植物神經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術前判斷的準確度均較高（92.3% vs 76.2%）。結論 新輔助化療對直腸癌手術的難度有一定的影響，但通過更為規(guī)范和準確的手術操作可保證手術的順利施行。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. 多學科協(xié)作診治模式下新輔助化療對直腸癌手術的影響. 中國普外基礎與臨床雜志, 2008, 15(2): 136-139. doi: 復制
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- 1. <><><><><><> [1]汪曉東,曹霖,羅德云,等.多學科協(xié)作診治模式下運行結直腸癌綜合治療的臨床對照研究[J].中國普外基礎與臨床雜志,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.結直腸癌外科應用技術的規(guī)范與創(chuàng)新(一)～(十二)[J].中國普外基礎與臨床雜志,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.