腹腔镜结肠癌根治术对局部进展期结肠癌患者腹腔、肠腔癌细胞脱落及腹膜纤溶功能的对照研究  

A controlled study of the effects of laparoscopic radical resection of colon cancer on the shedding of peritoneal and intestinal cancer cells and peritoneal fibrinolysis in patients with locally advanced colon cancer

作　　者：于北京 宋瑞[1] 张静文 Yu Beijing;Song Rui;Zhang Jingwen(Department of Gastrointestinal Surgery,Wanbei Coal and Electricity Group General Hospital,Anhui Suzhou 234200,China)

机构地区：[1]皖北煤电集团总医院胃肠外科,安徽宿州234200

出　　处：《中国医师进修杂志》2021年第8期737-742,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:探讨腹腔镜结肠癌根治术对局部进展期结肠癌患者腹腔、肠腔癌细胞脱落及腹膜纤溶功能的影响,以期为治疗提供一定参考。方法:选取2018年3月至2020年5月皖北煤电集团总医院局部进展期结肠癌患者76例,依据治疗术式不同分为两组,A组33例患者行腹腔镜结肠癌根治术,B组43例患者行开腹结肠癌根治术。比较两组手术有关指标、并发症与术前、术后1、3 d血清免疫功能指标(CD 4^(+)、CD 8^(+)、CD 4^(+)/CD 8^(+)),比较两组手术开始时、术后即刻腹膜组织的腹膜纤溶功能指标[腹膜组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制因子-1(PAI-1)]、腹腔癌细胞脱落阳性率和术前、术后即刻肠腔癌细胞脱落阳性率。结果:A组手术时间虽长于B组[(186.21±24.07)min比(149.49±17.82)min],但术后肛门排气时间、住院时间较B组短[(3.32±0.75)d比(3.84±1.02)d、(10.62±1.74)d比(12.85±2.26)d],术中出血量较B组少[(102.08±16.39)ml比(159.50±23.14)ml](P<0.05);A组并发症发生率低于B组[9.09%(3/33)比27.91%(12/43)](P<0.05);两组术后1和3 d的血清CD 4^(+)、CD 8^(+)、CD 4^(+)/CD 8^(+)水平较术前降低,但A组高于B组(P<0.05);腹膜纤溶功能:两组术后即刻腹膜组织t-PA水平较手术开始时降低,但A组较B组高,PAI-1水平较手术开始时提高,但A组较B组低(P<0.05);腹腔、肠腔癌细胞脱落情况:两组各时间点腹腔、肠腔癌细胞脱落阳性率比较差异无统计学意义(P>0.05)。结论:应用腹腔镜结肠癌根治术治疗局部进展期结肠癌可减轻手术创伤,促进术后恢复,减少并发症,减轻对机体免疫功能、腹膜纤溶功能的影响,且不增加术后腹腔、肠腔癌细胞脱落风险。Objective To investigate the effect of laparoscopic radical resection of colon cancer on the shedding of cancer cells in the abdominal cavity and intestinal cavity and peritoneal fibrinolysis in patients with locally advanced colon cancer,to provide a reference for treatment.Methods From March 2018 to May 2020,76 patients with locally advanced colon cancer in Wanbei Coal and Electricity Group General Hospital were selected and divided into group A(33 patients)and group B(43 patients)according to different treatment procedures.Group A underwent laparoscopic radical resection of colon cancer,group B underwent open radical resection of colon cancer.The related indexes,complications,and serum immune function indexes(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))before operation and 1 d and 3 d after operation,peritoneal fibrinolytic function indexes of the peritoneal tissue:peritoneal tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),the positive rate of peritoneal cancer cell shedding at the beginning of the operation and immediately after the operation,the positive rates of intestinal cancer cell shedding before and immediately after surgery were compared between the two groups.Results Although the operation time of group A was longer than that of group B:(186.21±24.07)min vs.(149.49±17.82)min,the postoperative anal exhaust time and hospital stay were shorter than those of group B:(3.32±0.75)d vs.(3.84±1.02)d,(10.62±1.74)d vs.(12.85±2.26)d,and the amount of intraoperative blood loss was less than that of group B:(102.08±16.39)ml vs.(159.50±23.14)ml,the differences were statistically significant(P<0.05).The complication rate of group A was lower than that of group B:9.09%(3/33)vs.27.91%(12/43)(P<0.05).Serum CD4^(+),CD8^(+),CD4^(+)/CD8^(+)levels in the two groups at 1 and 3 days after operation were lower than those before the operation,but those in group A were higher than those in group B(P<0.05).The t-PA level of the peritoneal tissue immediately after the operation in the two groups was l

关 键 词：结肠肿瘤 腹腔镜 癌细胞脱落 腹膜纤溶功能 

分 类 号：R735.35[医药卫生—肿瘤]