Despretz J, Otmezguine Y, Grimard L, Calitchi E, Julien M
Department of Surgery, CHU Henri Mondor, Créteil, France.
Dis Colon Rectum. 1990 Feb;33(2):113-6. doi: 10.1007/BF02055538.
Twenty-five patients with invasive adenocarcinoma of the rectum were treated by preoperative external irradiation (35 Gy), local excision, and peroperative placement of a plastic tube loop in the tumor bed for perioperative brachytherapy (20 or 25 Gy). Patients treated were too frail for radical resection (14 patients) or had refused a permanent colostomy (11 patients). With a mean follow-up of 40.5 months, there have been 5 patients with local relapse, 3 of whom had salvage abdominoperineal resections: 2 have no evidence of disease and 1 has developed distant metastatic disease. The 20 patients with local control have normally functioning sphincters; 1 has developed distant metastatic disease. This combined approach was designed to expand the curative role of local resection in carcinoma of the rectum. The surgical techniques are thoroughly described and the potential role and indications of this approach are discussed.
25例直肠浸润性腺癌患者接受了术前体外照射（35 Gy）、局部切除，并在肿瘤床术中放置塑料管环进行围手术期近距离放疗（20或25 Gy）。接受治疗的患者因身体过于虚弱而无法进行根治性切除（14例）或拒绝永久性结肠造口术（11例）。平均随访40.5个月，有5例出现局部复发，其中3例接受了挽救性腹会阴切除术：2例无疾病证据，1例出现远处转移性疾病。20例局部控制良好的患者括约肌功能正常；1例出现远处转移性疾病。这种联合方法旨在扩大局部切除在直肠癌治疗中的治愈作用。文中详细描述了手术技术，并讨论了这种方法的潜在作用和适应证。
