目的 探讨直肠癌术前同步放化疗疗效及预后.方法 选择2010年2月～2011年2月浙江省金华市中心医院收治的直肠癌患者80例,分为实验组与对照组,每组各40例.实验组术前采用同步放化疗,术后按需辅助性化疗；对照组术前不做放化疗,术后按需实施辅助性放化疗.对比两组患者术前与术后直肠癌降级情况、术后肛门功能情况；比较两组患者术后RECIST评价结果；比较术后24个月随访复发情况及生存质量.结果 ①放化疗后实验组T3、T4、N1所占比例低于放化疗前,放化疗后实验组T1、N0所占比例高于对照组,差异均有统计学意义(均P＜ 0.05).②实验组术后肛门功能C级以上比例高于对照组,差异有统计学意义(P＜0.05).③实验组完全缓解(CR)[32.5％ (13/40)]、部分缓解(PR) [52.5％ (21/40)]、总有效率[85.0％(34/40)]均高于对照组[5.0％(2/40)、25.0％(10/40)、30.0％(12/40)],差异有统计学意义(P＜0.05).④术后随访24个月,实验组无复发比例[90.0％(36/40)]高于对照组[62.5％ (25/40)],复发比例低于对照组,差异均有统计学意义(P＜0.05)；实验组生存质量优良者比例[42.5％(17/40)]高于对照组[15.0％(6/40)],生存质量差者比例低于对照组,差异均有统计学意义(P＜0.05).结论 直肠癌术前采用放化疗对直肠癌预后有较积极的影响,提高了治疗有效率,降低了术后复发率,改善直肠癌手术患者术后的生活质量.%Objective To observe the curative effect and prognosis of concurrent chemoradiotherapy before colorectal cancer surgery.Methods 80 patients with rectal cancer from February 2010 to February 2011 in Central Hospital of Jinhua City were selected and divided into experimental group and control group with 40 cases in each group.Experimental group was treated with concurrent chemoradiotherapy before colorectal cancer surgery; control group was treated without concurrent chemoradiotherapy before colorectal cancer surgery and with adjuvant radiation and chemotherapy after the surgery.Colorectal cancer relegation before and after the surgery,the anus function after the surgery were compared between the two groups; RECIST evaluation result after the surgery between the two groups were compared; recurrence and quality of life between the two groups after 24 months' follow-up visit were compared.Results ①The proportion of T3,T4,N1 in experimental group after the chemoradiotherapy were lower than those before the chemoradiotherapy,the proportion of T3,T4,N1 in experimental group after the chemoradiotherapy were higher than those before the chemoradiotherapy,the differences were statistically significant (P ＜ 0.05).②The proportion of C level of anal function in experimental group after the operation was higher than that in control group,the difference was statistically significant (P ＜ 0.05).③CR,PR,total effective rate in experimental group [32.5％ (13/40),52.5％ (21/40),85.0％ (34/40)] were all higher than those in control group [5.0％ (2/40),25.0％ (10/40),30.0％ (12/40)],the differences were statistically significant (P ＜ 0.05).(No recurrence ratio in experimental group [90.0％(36/40)] was higher than that in control group [62.5％(25/40)],recurrence ratio in experimental group was lower than that in control group,the differences were statistically significant (P ＜ 0.05); the rate of excellent quality of life in experimental group [42.5％ (17/40)]was higher than that in control group [15.0％ (6/40)],the rate of poor quality of life in experimental group was lower than in control group,the differences were statistically significant (P ＜ 0.05).Conclusion Adopting chemoradiotherapy to rectal cancer patients before rectal cancer surgery has positive influence on their prognosis,it can improve treatment effective rate and reduce postoperative recurrence rate,and can also improve patients' postoperative life quality.
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