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目的探讨直肠癌术前短程放疗后手术间隔时间的差异对会阴部切口愈合的影响。方法选取在山东省肿瘤医院2008年12月至2011年12月期间住院治疗的128例局部进展期低位直肠癌患者,并根据患者意愿,将128例患者分成3组:30例为直接手术组;55例行术前短程放疗(25 Gy,5×5 Gy),治疗完成后1周内行手术治疗,设为1周手术组;43例行术前短程放疗(25 Gy,5×5 Gy),治疗完成后4周行手术治疗,设为4周手术组。结果会阴部切口甲级愈合46例,乙级愈合52例,丙级愈合30例。直接手术组和4周手术组的丙级愈合发生率分别为6%和14%,差异无统计学意义(P>0.05)。1周手术组和4周手术组相比,丙级愈合发生率分别为40%和14%,差异有统计学意义(P<0.01)。经多因素分析,术前短程放化疗后手术间隔期的选择是影响会阴部切口愈合的独立因素。结论适当延长直肠癌术前短程放疗后的手术间隔期可明显地降低术后会阴部切口延迟愈合发生率。
Objective To investigate the effect of preoperative short-term radiotherapy on the healing of perineum incision after surgery. Methods A total of 128 patients with locally advanced low rectal cancer admitted to Shandong Tumor Hospital from December 2008 to December 2011 were enrolled and 128 patients were divided into 3 groups according to patients’ wishes: 30 patients received direct surgery; A total of 55 patients underwent preoperative short-range radiotherapy (25 Gy, 5 × 5 Gy). One week after the completion of the operation, they were operated on for 1 week. Forty-three patients underwent preoperative short-range radiotherapy (25 Gy, 5 × 5 Gy) Surgical treatment was performed 4 weeks after the completion of the treatment and was set as a 4-week surgery group. Results perineal incision grade healed in 46 cases, 52 cases of grade B heal, grade C healed in 30 cases. The incidences of grade C healing in the direct surgery group and the 4-week surgery group were 6% and 14%, respectively, with no significant difference (P> 0.05). The incidences of grade C healing were 40% and 14% in the 1-week surgery group compared with those in the 4-week surgery group, respectively, with significant differences (P <0.01). After multivariate analysis, the choice of surgical interval after preoperative brachytherapy is an independent factor affecting perineal incision healing. Conclusion Appropriately prolonging preoperative short-term radiotherapy after rectal cancer surgery interval can significantly reduce the incidence of postoperative perineal incision delayed union.