[1]刘 婷,王春毅.盆腔MRI评估对局部进展期直肠癌患者新辅助放化疗后手术时机选择的影响[J].医学信息官方网站,2022,35(15):63-67.[doi:10.3969/j.issn.1006-1959.2022.15.013]
　LIU Ting,WANG Chun-yi.Effect of Pelvic MRI Evaluation on Surgical Timing of Locally Advanced Rectal Cancer Patients After Neoadjuvant Chemoradiotherapy[J].Medical Information,2022,35(15):63-67.[doi:10.3969/j.issn.1006-1959.2022.15.013]
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盆腔MRI评估对局部进展期直肠癌患者新辅助放化疗后手术时机选择的影响()
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《医学信息》官方网站[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年15期
页码:
63-67
栏目:
论著
出版日期:
2022-08-01

文章信息/Info

Title:
Effect of Pelvic MRI Evaluation on Surgical Timing of Locally Advanced Rectal Cancer Patients After Neoadjuvant Chemoradiotherapy
文章编号:
1006-1959（2022）15-0063-05
作者:
刘 婷; 王春毅
（重庆医科大学附属第一医院胃肠外科，重庆 400016）
Author(s):
LIU Ting; WANG Chun-yi
(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
关键词:
局部进展期直肠癌; 新辅助放化疗; 手术时机
Keywords:
Locally advanced rectal cancer; Neoadjuvant chemoradiotherapy; Timing of surgery
分类号:
R735.3
DOI:
10.3969/j.issn.1006-1959.2022.15.013
文献标志码:
A
摘要:
目的 研究术前盆腔增强MRI评估对局部进展期直肠癌患者新辅助放化疗（nCRT）后nCRT手术时机的影响。方法 回顾性分析重庆医科大学附属第一医院2017年1月-2019年12月收治的局部进展期且完成nCRT的直肠癌患者85例，根据盆腔磁共振评估的环周切缘（CRM）、直肠壁外血管侵犯（EMVI）情况及手术间隔时间，分为A1组（CRM、EMVI均为阳性、手术间隔时间8~10周）20例、A2组（EMVI、CRM均为阳性、手术间隔时间11~12周）24例、B1组（CRM、EMVI其中一个为阳性、手术间隔时间8~10周）23例和B2组（CRM、EMVI其中一个为阳性、手术间隔时间11~12周）18例。比较各组临床特征、手术和病理结果，并对病理完全缓解（pCR）进行单因素和多因素分析。结果 各组性别、年龄、BMI、nCRT前CEA水平、肿瘤分期、肿瘤下缘距肛缘距离比较，差异均无统计学意义（P＞0.05）；A1组住院费用和保肛数多于A2组，B1组预防性造瘘数多于B2组，差异有统计学意义（P＜0.05）；各组手术方式、手术时间、术中出血量、术后住院时间、病理退缩分级TRG、pCR、病检淋巴结总数、病检淋巴结阳性数、吻合口瘘、感染、肺炎、肠梗阻比较，差异无统计学意义（P＞0.05）；单因素分析显示，nCRT前CEA水平是pCR的影响因素（P＜0.05）；多因素分析显示，手术时间间隔、nCRT前CEA水平、BMI、EMVI、临床T分期均不是pCR的独立预测因素。结论 对于局部进展期直肠癌患者，在CRM、EMVI均为阳性时选择8~10周手术，可获得更高的保肛机会；在CRM、EMVI其中一个为阳性时，选择11~12周手术，可减少预防性造瘘的比例，提高pCR率。
Abstract:
Objective To study the effect of preoperative pelvic enhanced MRI evaluation on the timing of surgery in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy(nCRT).Methods A retrospective analysis was performed on 85 patients with locally advanced rectal cancer who underwent nCRT in the First Affiliated Hospital of Chongqing Medical University from January 2017 to December 2019. According to pelvic magnetic resonance assessment, circumferential resection margin (CRM), extrarectal wall vascular invasion (EMVI) and operation time interval were evaluated, they were divided into group A1 (CRM, EMVI were positive, the operation interval was 8-10 weeks) 20 cases, group A2 (EMVI, CRM were positive, the operation interval was 11-12 weeks) 24 cases, group B1 (CRM, EMVI one was positive, the operation interval was 8-10 weeks) 23 cases and group B2 (CRM, EMVI one was positive, the operation interval was 11-12 weeks) 18 cases. The clinical features, surgical and pathological results of each group were compared, and the pathological complete remission (pCR) was analyzed by univariate and multivariate analysis.Results There were no significant differences in gender, age, BMI, CEA before nCRT, tumor stage and distance from the lower edge of the tumor to the anal margin between the groups (P>0.05). The cost of hospitalization and anal preservation in group A1 were higher than those in group A2, and the number of preventive fistula in group B1 was higher than that in group B2, the difference was statistically significant (P<0.05). There was no significant difference in operation mode, operation time, intraoperative blood loss, postoperative hospital stay, pathological regression grade TRG, pCR, total number of lymph nodes, positive number of lymph nodes, anastomotic leakage, infection, pneumonia and intestinal obstruction between the groups (P>0.05). Univariate analysis showed that CEA level before nCRT was the influencing factor of pCR (P<0.05). Multivariate analysis showed that operation time interval, CEA level before nCRT, BMI, EMVI and clinical T stage were not independent predictors of pCR.Conclusion For patients with locally advanced rectal cancer, when CRM and EMVI are positive, 8-10 weeks of surgery can obtain higher anal preservation opportunities ; when one of CRM and EMVI was positive, 11-12 weeks of surgery can reduce the proportion of preventive fistula and improve the pCR rate.

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更新日期/Last Update: 1900-01-01