Stenosis and distortion of reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection procedure for patients with local advanced mid-low rectal cancer: risk factors and clinical management

郑宏途; 杨立峰

doi:10.19401/j.cnki.1007-3639.2018.04.008

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Stenosis and distortion of reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection procedure for patients with local advanced mid-low rectal cancer: risk factors and clinical management

更新时间：2026-01-27

- Stenosis and distortion of reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection procedure for patients with local advanced mid-low rectal cancer: risk factors and clinical management
- China Oncology Vol. 28, Issue 4, Pages: 290-296(2018)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院大肠外科，复旦大学上海医学院肿瘤学系,上海,200032
  2. 复旦大学附属肿瘤医院放疗科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2018.04.008
  CLC： R735.37
- Published Online：12 June 2018，
  
  Published：12 June 2018
- 稿件说明：
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黄韬,郑宏途,杨立峰,等. 新辅助放化疗-直肠前切除手术后重建直肠狭窄的临床危险因素分析[J]. 中国癌症杂志, 2018, 28(4): 290-296.

郑宏途, 杨立峰. Stenosis and distortion of reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection procedure for patients with local advanced mid-low rectal cancer: risk factors and clinical management[J]. China Oncology, 2018, 28(4): 290-296.
黄韬,郑宏途,杨立峰,等. 新辅助放化疗-直肠前切除手术后重建直肠狭窄的临床危险因素分析[J]. 中国癌症杂志, 2018, 28(4): 290-296. DOI： 10.19401/j.cnki.1007-3639.2018.04.008.

郑宏途, 杨立峰. Stenosis and distortion of reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection procedure for patients with local advanced mid-low rectal cancer: risk factors and clinical management[J]. China Oncology, 2018, 28(4): 290-296. DOI： 10.19401/j.cnki.1007-3639.2018.04.008.

摘要

背景与目的：新辅助放化疗已经成为局部进展期中低位直肠癌的标准治疗模式，能够有效地降低局部肿瘤的复发率。该研究旨在分析新辅助放化疗联合直肠前切除后重建直肠狭窄和扭曲的危险因素，探讨临床干预措施。方法：基于复旦大学附属肿瘤医院大肠癌数据库以及放疗临床登记数据库，通过肠镜进行狭窄分级，分析狭窄的相关危险因素。利用SPSS 19.0软件进行统计分析，采用卡方检验对风险因素进行评估。结果：269例患者入组，严重狭窄发生率达32.7%。狭窄相关危险因素主要为：吻合口瘘和保护性造瘘的应用。40例（28%）患者近端造瘘未能在1年内还纳，狭窄是主要原因。结论：重建直肠的扭曲和狭窄是新辅助放化疗联合直肠前切除手术面临的一个棘手问题。直肠扭曲和狭窄的发生和保护性造瘘以及吻合口瘘具有显著的相关性。

Abstract

Background and purpose: Neoadjuvant chemoradiotherapy has become standard treatment modality for locally advanced mid-low rectal cancer. This study aimed to analyze the risk factors of stenosis and distortion in reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection

and to discuss its clinical management methods. Methods: In this study

we retrospectively and continuously collected the data of patients in the colorectal database of colorectal surgery and clinical register database of radiation. Stenosis grading system was constructed by means of electronic fibrous colonoscope. SPSS 19.0 software package was used in the study

standard chi-square test was used for risk factor analysis

and P0.05 was set as statistical significance. Results: A total of 269 patients received neoadjuvant chemoradiotherapy and anterior resection. The incidence of severe stenosis was 32.7%. Anastomotic leakage and prophylactic stoma were important risk factors. Forty cases of prophylactic or salvage stoma could not be restored within 1 year

among which 72.5% was because of stenosis. Conclusion: Stenosis and distortion of reconstructed rectum after neoadjuvant chemoradiotherapy and anterior resection treatment modality is a new clinical issue which is closely related with leakage and prophylactic stoma.

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