中文摘要：

目的探讨新辅助同步放化疗联合直肠全系膜切除术（total mesorectal excision,TME）用于局部进展期中低位直肠癌治疗的可行性与临床价值。方法 111例局部进展期（T3～4 N0～2 M0）中低位直肠癌术前接受同步放化疗,放疗剂量50 Gy,化疗包括奥沙利铂＋卡培他滨的联合化疗方案及不含铂类药物的单药化疗方案。共105例患者同步放化疗结束后2～10周内完成了肿瘤根治性（R0）手术,可进行疗效的病理学评价。结果 105例患者获得根治性切除,切缘均阴性,42例（37.8%,42/111）患者成功实施保肛手术;18例临床-影像分期为T4期患者中,15例（83.3%）新辅助放化疗后获得根治性切除（R0）。所有患者手术及术后恢复顺利,无严重手术并发症;术后病理示肿瘤完全消退15例（14.3%）,重度消退26例（24.8%）,中度消退40例（38.1%）,轻度及无消退24例（22.8%）。结论新辅助同步放化疗联合TME手术安全可行,可提高局部进展期中低位直肠癌的根治性切除率与保肛率,不增加手术并发症,是局部进展期中低位直肠癌的优选治疗模式。

英文摘要：

Objective To explore the value and feasibility of combined neoadjuvant radiochemotherapy with TME in the treatment of locally advanced mid-distal rectal cancer.Methods One hundred and eleven patients with locally advanced mid-distal rectal cancer（T3～4N0～2M0） underwent preoperative radiochemotherapy with a dose of 50 Gy.Chemotherapy regimens were oxaliplatin combined capecitabine（combination group） and the single agent alone without oxaliplatin（single drug group）.One hundred and five patients received radical（R0） TME operations within 2～10 weeks after radiochemotherapy and the efficacy of the radiochemotherapy could be evaluated according to the postoperative pathological results.Results Radical TME were carried out on 105 patients with clear margin.Sphincter-sparing surgery was performed in 42（37.8%） patients.Radical（R0） TME operations were performed in 15（83.3%） out of the 18 T4 patient,staged by the MRI and CT,after radiochemotherapy.There were no severe complications during the treatment of neoadjuvant radiochemotherapy or operation.There were 15 cases（14.3%） with complete tumor regression,26 cases（24.8%） with maximal tumor regression,40 cases（38.1%） with moderate tumor regression and 24 cases（22.8%） with minimal tumor regression.Conclusion It is concluded that the combined neoadjuvant radiochemotherapy with TME leads to increased sphincter-sparing and radical（R0） surgery with no addition of complications,which is a feasible treatment on locally advanced mid-distal rectal cancer.It should be a preferred regimen for the locally advanced mid-distal rectal cancer.