摘要
新辅助放化疗后施行根治性切除术目前已成为中低位局部进展期直肠癌的标准治疗模式。然而，传统的根治手术创伤大，术中及术后并发症多，部分患者需要行暂时性或永久性造口，出现性功能或排尿功能障碍，导致生命质量下降。“保直肠”手术是新辅助放化疗时代直肠肿瘤治疗理念的进一步升华，通过最小的创伤，使患者最大获益，目前已经越来越多地被应用于新辅助放化疗后的局部进展期直肠癌中。由于现有研究缺乏高级别循证医学证据的支持，远期疗效有待更多的大宗、多中心、随机对照研究试验数据进一步验证。施行“保直肠”手术的关键在于评估患者原发病灶和区域淋巴结有无癌细胞残留，准确筛选新辅助放化疗后完全缓解患者。
Neoadjuvant chemoradiotherapy （nCRT） and subsequent radical resection have become the standard care of locally advanced rectal cancer （LARC）. However, conventional radical surgery is associated with high intra-and post-operative morbidities, and a temporary or permanent stoma in some cases, impaired sexual and urinary function, and it eventually impair the quality of life. ＂Rectum-preserving surgery＂ is a novel concept in the era of nCRT, which will maximally benefit patients through the minimized injuries. This strategy has been increasingly utilized in LARC following nCRT. Nevertheless, it lacks high-level evidence of evidence based medicine, and the long term oncological safety remains to be determined by larger, multicenter, randomized clinical trials. The crucial aspect of ＂rectum-preserving surgery＂ is to accurately evaluate the status of primary tumor and metastatic lymph nodes, and thus to selective patients who could benefit from this strategy most.
作者
池畔
孙艳武
Chi Pan Sun Yanwu.(Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第7期662-667,共6页
Chinese Journal of Digestive Surgery
基金
国家临床重点专科建设资助项目[卫办医政函（2012）649号]
关键词
直肠肿瘤
新辅助放化疗
器官保留手术
Rectal neoplasms
Neoadjuvant chemoradiotherapy
Organ preserving surgery
作者简介
通信作者：池畔，Email：cp3169@163．com
