局部进展期直肠癌新辅助放化疗后不同手术方式对应激反应及远期疗效的影响  

Effects of different surgical methods on stress respons and long-term efficacy after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer

作　　者：徐晔青 邱爱珠[2] 彭峰 王劲 谭祥云 龚晓松 XU Ye-qing;QIU Ai-zhu;PENG Feng;WANG Jin;TAN Xiang-yun;GONG Xiao-song(Department of General Surgery,the Affliated Zhuzhou Hospital Xiangya Medical College CSU,Zhuzhou 412007,China;Department of Basic Medicine,Hunan College of Traditional Chinese Medicine,Zhuzhou 412012,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院普外科,湖南株洲412007 [2]湖南中医药高等专科学校,湖南株洲412012

出　　处：《中国现代普通外科进展》2021年第7期538-542,547,共6页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨局部进展期直肠癌(LARC)患者新辅助放化疗后不同手术方式对其血清淀粉样蛋白A(SAA)、皮质醇(CS)、人生长激素释放肽(Ghrelin)水平及远期疗效的影响。方法:选取2014年3月—2016年3月收治的LARC患者74例,依据手术方式不同分为传统组和腹腔镜组两组,每组各37例。两组均接受新辅助放化疗,放化疗结束后6~8周,传统组行传统全直肠系膜切除术(TME),腹腔镜组行腹腔镜TME。对比两组手术情况、术后并发症发生率、手术前后血清SAA、CS、Ghrelin、炎症因子[白细胞介素6(IL-6)、IL-10、C反应蛋白(CRP)]水平、外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))水平及随访3年远期疗效。结果:腹腔镜组手术时间、术中出血量及住院时间均少于传统组(P<0.05);术后1 d、7 d,腹腔镜组血清SAA、CS、Ghrelin水平低于传统组(P<0.05);术后1 d、7 d,腹腔镜组血清IL-6、IL-10、CRP水平低于传统组(P<0.05);术后7 d,腹腔镜组CD3^(+)、CD4^(+)、CD8^(+)水平高于传统组(P<0.05);两组术后并发症发生率相比,差异无统计学意义(P>0.05);随访3年,两组3年生存率相比,差异无统计学意义(P>0.05)。结论:与传统TME比较,LARC患者新辅助放化疗后实施腹腔镜TME,远期疗效良好,能显著减轻应激反应,降低对机体免疫功能的影响,缩短术后康复进程,且安全性高。Objective: To investigate the levels of serum amyloid A(SAA), cortisol(CS), human growth hormone releasing peptide(Ghrelin) in patients with locally advanced rectal cancer(LARC) after neoadjuvant chemotherapy Impact of the period. Methods: From March 2014 to March 2016, 74 LARC patients were selected and divided into traditional group and laparoscopic group according to different surgical methods, with 37 cases in each group. Both groups received neoadjuvant chemoradiotherapy, and six to eight weeks after the end of chemoradiotherapy, the traditional group underwent traditional total mesorectal excision(TME) and the laparoscopic group underwent laparoscopic TME. The operation conditions, postoperative complications, serum SAA, CS, Ghrelin, the levels of inflammatory factors [interleukin 6(IL-6), IL-10, C-reactive protein(CRP)] and the levels of peripheral blood T lymphocyte subsets(CD3^(+), CD4^(+), CD8^(+)), and long-term efficacy after three years of followup were compared between the two groups. Results: The operation time, intraoperative blood loss and length of hospital stay in the laparoscopic group were less than those in the traditional group(P<0.05). 1 and 7 days after operation, the serum SAA, CS, and Ghrelin levels in the laparoscopic group were lower than those in the traditional group(P<0.05). 1 and 7 days after operation, the serum levels of IL-6, IL-10 and CRP in the laparoscopic group were lower than those in the traditional group(P<0.05). 7 days after operation, the CD3^(+), CD4^(+), and CD8^(+) levels in the laparoscopic group were higher than those in the traditional group(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). After 3 years of follow-up, there was no significant difference in the 3-year survival rate between the two groups(P>0.05). Conclusion: Compared with the traditional TME, laparoscopic TME after the neoadjuvant chemoradiotherapy has good long-term effects, can significantly reduce the stress response, re

关 键 词：局部进展期直肠癌 新辅助放化疗 腹腔镜全直肠系膜切除术 淀粉样蛋白A 皮质醇 人生长激素释放肽 

分 类 号：R735.37[医药卫生—肿瘤]