SEMS联合限期手术治疗梗阻性左半结肠癌的近期疗效及对免疫功能和转移复发的影响  

Short-term efficacy of SEMS combined with limited surgery in the treatment of obstructive left hemicolon cancer and its effect on immune function and metastasis and recurrence

作　　者：李小龙 谢明[1] 周裕淮 刘天云 LI Xiao-long;XIE Ming;ZHOU Yu-huai(Department of General Surgery,the First Affiliated Hospital of Shaoyang University,Shaoyang Hunan 422000,China)

机构地区：[1]邵阳学院附属第一医院普外科,湖南邵阳422000

出　　处：《临床和实验医学杂志》2022年第11期1170-1174,共5页Journal of Clinical and Experimental Medicine

基　　金：湖南省科技创新计划项目(编号:S2018SFYLJS0571)。

摘　　要：目的探讨自膨式支架置入(SEMS)联合手术治疗梗阻性左半结肠癌的近期疗效及对免疫功能、术后转移复发的影响。方法回顾性分析2017年12月至2020年12月在邵阳学院附属第一医院普外科治疗的62例梗阻性左半结肠癌患者临床资料,根据治疗方案不同分为SEMS组(n=30)和急诊手术组(n=32)。SEMS组给予SEMS联合限期手术,急诊手术组给予传统急诊手术。比较两组围手术期资料、并发症、免疫功能和3年总生存率、复发转移率。结果两组手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间和术后住院时间对比差异均无统计学意义(P>0.05)。SEMS组术前血清白蛋白水平、一期切除吻合率、腹腔镜手术率为(35.86±3.69)g/L、100.00%、80.00%,显著增高急诊手术组[(31.24±3.25)g/L、78.12%、15.62%],淋巴结清扫数目为(18.40±5.49)枚,多于急诊手术组[(15.03±4.83)枚],造口率、围术期并发症发生率为16.67%、46.67%,显著低于急诊手术组(50.00%、78.12%),差异均有统计学意义(P<0.05)。手术后3 d,SEMS组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于急诊手术组,差异均有统计学意义(P<0.05)。患者随访3~36个月,SEMS组3年总生存率、复发转移率分别为80.00%、6.67%,与急诊手术组的78.12%、11.76%对比,差异无统计学意义(P>0.05)。结论SEMS应用于梗阻性左半结肠癌患者治疗中,可有效降低造口率,提高一期吻合率,增加淋巴结清扫数目,降低并发症发生率,并可保护免疫功能,且对术后转移复发和远期生存无明显影响。Objective To investigate the short-term efficacy of self-expandable metallic stenting(SEMS)combined with surgery in the treatment of obstructive left hemicolon cancer and its influence on immune function and postoperative metastasis and recurrence.Methods The clinical data of patients with obstructive left hemicolon cancer treated in the Gepartment of General Surgery of the First Affiliated Hospital of Shaoyang University from December 2017 to December 2020 were retrospectively analyzed.According to different treatment regimens,they were divided into SEMS group(n=30)and emergency operation group(n=32).The SEMS group was given SEMS combined with time-limited surgery,and the emergency surgery group was given traditional emergency surgery.The perioperative data,complications,immune function,3-year overall survival rate and recurrence and metastasis rate were compared between the two groups.Results There was no significant difference in operation time,intraoperative blood loss,number of lymph node dissection,postoperative anal exhaust time and postoperative hospital stay between the two groups(P>0.05).The level of serum albumin before operation,anastomosis rate of one-stage resection,and laparoscopic surgery rate were(35.86±3.69)g/L,100.00%,80.00% in the SEMS group,which were significantly higher in the emergency operation group[(31.24±3.25)g/L,78.12%,15.62%],the number of lymph nodes dissected was(18.40±5.49),which were more than the emergency surgery group[(15.03±4.83)],the stoma rate and perioperative complication rates were 16.67%,46.67%,which were significantly lower than the emergency operation group(50.00%,78.12%),and the differences were statistically significant(P<0.05).At 3 days after operation,the levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) in SEMS group were higher than those in emergency operation group,and the differences were statistically significant(P<0.05).Patients were followed up for 3~36 months.The 3-year overall survival rate and recurrence and metastasis rate in the SEMS group were 80.00%

关 键 词：自膨式支架 左半结肠癌 肠梗阻 淋巴结清扫 免疫功能 转移复发 

分 类 号：R735.35[医药卫生—肿瘤]