Objective To explore the effect of preoperative FOLFOX chemotherapy combined with radiotherapy in patients with locally advanced rectal cancer who underwent single-port access laparoscopic abdominoperineal resection for anus and rectum (Miles surgery) under jackknife position.Methods Totally 136 patients with locally advanced rectal cancer who underwent single-port access laparoscopic abdominoperineal resection for anus and rectum (Miles surgery) under jackknife position from March 2009 to May 2012 were randomly divided into observation group and control group (68 cases in each group).Preoperative FOLFOX chemotherapy combined with radiotherapy was given in observation group and single radiotherapy was given in control group.The visual analog scale (VAS) score before chemotherapy combined with radiotherapy (or radiotherapy) and after surgery,short-term and long term curative effect,adverse reaction were compared between groups.Results The VAS scores before chemotherapy combined with radiotherapy (or radiotherapy) and after surgery,the remission rate of pain 1 month after surgery were not significantly different between groups (P ＞ 0.05).One month after operation,the effective rate in observation group was significantly higher than that in control group [64.7％ (44/68) vs 38.2％ (26/68)] (P =0.022).The incidence of adverse reactions was not significantly different between groups (P ＞ 0.05).The 1-and 2-year survival rate in observation group was significantly higher than those in control group [81.4％ vs 50.0％,65.1％ vs 25.6％] (both P ＜ 0.01);the 3-year survival rate was not significantly different between groups (11.8％ vs 10.3％) (P =0.78).Conclusion In Single-port access laparoscopic Miles surgery under jackknife position,preoperative FOLFOX chemotherapy combined with radiotherapy can improve the short-term effect,1-and 2-year survival rate compared with preoperative single radiotherapy in patients with locally advanced rectal cancer.%目的 探讨单孔腹腔镜折刀位腹会阴联合直肠癌根治术(Miles术)术前应用FOLFOX联合同步放疗对局部晚期低位直肠癌的疗效.方法 纳入2009年3月至2012年5月第二军医大学附属上海长海医院拟行单孔腹腔镜折刀位Miles术的局部晚期低位直肠癌患者136例,按随机数字表法分为观察组和对照组(各68例),观察组术前给予FOLFOX化疗方案联合同步放疗,对照组术前给予单纯标准放疗.比较2组同步放化疗或标准放疗前及术后疼痛视觉模拟量表(VAS)评分、近远期疗效及不良反应发生情况.结果 2组患者同步放化疗或标准放疗前和手术后不同时点VAS评分及术后1个月疼痛缓解率差异无统计学意义(P＞0.05);术后1个月观察组总有效率明显高于对照组[64.7％(44/68)比38.2％(26/68)],差异有统计学意义(P =0.022);2组不良反应发生率差异无统计学意义(P＞0.05).观察组1、2年生存率高于对照组[81.4％比50.0％,65.1％比25.6％],差异有统计学意义(均P＜0.01),3年生存率2组分别为11.8％和10.3％,差异无统计学意义(P=0.78).结论 单孔腹腔镜折刀位Miles术治疗晚期低位直肠癌时,术前给予FOLFOX化疗方案联合同步放疗与术前给予单纯放疗比较,能够明显提高近期疗效和1、2年生存率.
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