腹腔镜与开腹直肠癌根治术患者循环肿瘤细胞水平变化及对肿瘤微转移的影响  

Changes of circulating tumor cell levels in patients undergoing laparoscopic and open radical resection of rectal cancer and their influence on tumor micrometastasis.

作　　者：傅厚丰 李炳[1] 梁振雄 刘有良 FU Hou-feng;LI Bing;LIANG Zhen-xiong(Department of General Surgery,Qionghai People's Hospital,Qionghai Hainan 571400,China)

机构地区：[1]海南省琼海市人民医院普通外科,海南琼海571400 [2]连云港市第二人民医院手术室,江苏连云港222000

出　　处：《临床和实验医学杂志》2022年第1期50-54,共5页Journal of Clinical and Experimental Medicine

基　　金：海南省医药卫生科研项目(编号:17A000107)。

摘　　要：目的探讨腹腔镜与开腹直肠癌根治术对患者循环肿瘤细胞(CTC)水平、肿瘤微转移的影响。方法前瞻性选取2017年7月至2020年6月琼海市人民医院收治的直肠癌患者130例,根据随机数字表法将其分为开腹组(n=65)、腹腔镜组(n=65)。比较两组围手术期指标,包括手术时间、术中出血量、术后排气时间、留置尿管时间、引流管拔除时间、住院时间。观察两组术前、术后3个月的CTC计数以及术后CTC的阳性率。术后CTC阳性则提示有肿瘤微转移风险,并据此分成有风险组、无风险组,经Logistic多元回归模型分析患者肿瘤微转移风险发生的影响因素。结果腹腔镜组术中出血量低于开腹组,术后排气时间、留置尿管时间、引流管拔除时间、住院时间短于开腹组,差异均有统计学意义(P <0.05)。两组术后CTC计数均低于术前,差异均有统计学意义(P <0.05),但组间比较差异无统计学意义(P> 0.05)。腹腔镜组术后CTC阳性率为12.31%,与开腹组的16.92%比较差异无统计学意义(P> 0.05)。Logistic多元回归分析提示,脉管癌栓(OR=1.985,95%CI:1.200~3.284)、淋巴结转移(OR=4.515,95%CI:1.965~10.374)、术中牵拉伤(OR=3.527,95%CI:1.621~7.674)是患者术后肿瘤微转移风险发生的影响因素(P <0.05)。结论腹腔镜与开腹直肠癌根治术均能降低术后CTC计数,两种术式的肿瘤微转移风险接近,但腹腔镜手术能进一步促进机体功能恢复。患者术后肿瘤微转移风险的发生主要与脉管癌栓、淋巴结转移、术中牵拉伤有关。Objective To explore the effects of laparoscopic and open radical resection of rectal cancer on the level of circulating tumor cells( CTC) and tumor micrometastasis. Methods A total of 130 patients with rectal cancer admitted to Qionghai People’s Hospital from July2017 to June 2020 were prospectively selected divided into laparotomy group( n = 65) and laparoscopic group( n = 65) according to the random number table method. The perioperative indicators of the two groups were compared,including operation time,intraoperative blood loss,postoperative exhaust time,indwelling catheter time,drainage tube removal time,and hospital stay. The circulating tumor cell( CTC) counts before and3 months after surgery,and the positive and negative rates of CTC after surgery were observed. A positive CTC after surgery indicates the risk of tumor micrometastasis. Based on this,it was divided into risk group and no risk group. The factors affecting the risk of tumor micrometastasis were analyzed by Logistic multiple regression model. Results The intraoperative blood loss in the laparoscopic group was lower than that in the open group,and the postoperative exhaust time,indwelling catheter time,drainage tube removal time,and hospital stay were shorter than those in the open group,the differences were statistically significant( P < 0. 05). The postoperative CTC counts of the two groups were lower than those before the operation,the differences were statistically significant( P < 0. 05),but there was no statistically significant difference between the groups( P> 0. 05). The positive rate of CTC in the laparoscopic group was 12. 31%,compared with 16. 92% in the open group,the difference was not statistically significant( P > 0. 05). Logistic multiple regression analysis indicated that vascular tumor thrombus( OR = 1. 985,95% CI : 1. 200-3. 284),lymph node metastasis( OR = 4. 515,95% CI : 1. 965-10. 374),intraoperative stretch injury( OR = 3. 527,95% CI : 1. 621-7. 674) was an influencing factor for the risk of postoperative tumor microm

关 键 词：直肠癌 腹腔镜手术 开腹手术 循环肿瘤细胞 肿瘤微转移 

分 类 号：R735.37[医药卫生—肿瘤]