新辅助同步放化疗与食管癌根治术治疗胸中上段食管癌患者的临床应用效果  

Clinical Application Effect of Neoadjuvant Concurrent Chemoradiotherapy and Radical Esophagectomy for Patients with Upper Thoracic Esophageal Cancer

作　　者：林涌 张文山 许辉明 LIN Yong;ZHANG Wenshan;XU Huiming(Department of Cardiothoracic Surgery,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou,Fujian Province,363000 China)

机构地区：[1]福建医科大学附属漳州市医院胸心外科,福建漳州363000

出　　处：《中外医疗》2022年第28期19-23,共5页China & Foreign Medical Treatment

摘　　要：目的探讨新辅助同步放化疗与食管癌根治术治疗胸中上段食管癌患者的临床应用效果。方法回顾性选择2015年1月—2018年10月于福建医科大学附属漳州市医院治疗的70例胸中上段食管癌患者作为研究对象,依据治疗方式不同分成对照组(n=35)和观察组(n=35)。对照组予以微创食管癌根治术治疗,观察组施以新辅助同步放化疗与食管癌根治术治疗,比较两组肿瘤标志物水平、临床治疗效果、细胞免疫指标水平及不良反应发生率。结果治疗后2周,观察组细胞角蛋白19片断水平(6.56±1.67)ng/mL低于对照组的(10.52±1.61)ng/mL,差异有统计学意义(t=10.099,P<0.05);观察组患者远处转移率8.57%及复发率14.29%均低于对照组的28.57%和51.43%,差异有统计学意义(χ^(2)=4.629、10.944,P<0.05);观察组治疗后1年及3年生存率为88.57%、68.57%均高于对照组的68.57%和42.86%,差异有统计学意义(χ^(2)=4.158、4.690,P<0.05);治疗后,观察组CD4+水平(41.13±3.48)μl、CD3+水平(80.19±15.07)μl、NK水平(29.67±5.89)μl高于对照组,CD8+水平(23.01±3.07)μl低于对照组,差异有统计学意义(t=7.842、8.828、13.472、5.837,P<0.05);观察组治疗期间出现头晕头痛8.57%(3/35)、皮肤反应5.71%(2/35)、胃肠道反应11.43%(4/35)、肝肾毒素反应8.57%(3/35)、疲劳乏力5.71%(2/35)及白细胞减低11.43%(4/35)。结论新辅助同步放化疗与食管癌根治术治疗胸中上段食管癌疗效显著,有效降低肿瘤标志物水平,改善细胞免疫水平,促进机体恢复,且术前新辅助同步放化疗产生的不良反应较少。Objective To investigate the clinical effect of neoadjuvant concurrent chemoradiotherapy and radical esophagectomy for the treatment of patients with esophageal cancer in the middle and upper thoracic segments.Methods A total of 70 patients with esophageal cancer in the middle and upper thoracic segments who were treated in hospital Zhangzhou Affiliated Hospital of Fujian Medical University from January 2015 to October 2018 were retrospectively selected as study subjects,and divided into control group(n=35)and observation group(n=35)according to different treatment methods.The control group was treated with minimally invasive radical esophagectomy,and the observation group was treated with neoadjuvant concurrent chemoradiotherapy and radical esophagectomy.The levels of tumor markers,clinical treatment effects,cellular immune indexes,and incidence of adverse reactions were compared between the two groups.Results Two weeks after treatment,the level of cytokeratin 19 fragments in the observation group was(6.56±1.67)ng/mL lower than that in the control group(10.52±1.61)ng/mL,and the difference was statistically significant(t=10.099,P<0.05).The distant metastasis rate of 8.57%and the recurrence rate of 14.29%in the observation group were lower than 28.57%and 51.43%in the control group,and the difference was statistically significant(χ^(2)=4.629,10.944,P<0.05).The 1-year and 3-year survival rates of the observation group after treatment were 88.57%and 68.57%,which were higher than those of the control group,68.57%and 42.86%,and the difference was statistically significant(χ^(2)=4.158,4.690,P<0.05).After treatment,the CD4+level(41.13±3.48)μl,CD3+level(80.19±15.07)μl,and NK level(29.67±5.89)μl in the observation group were higher than those in the control group,and the CD8+level was(23.01±3.07)μl lower than that in the control group,the difference was statistically significant(t=7.842,8.828,13.472,5.837,P<0.05).During the treatment period in the observation group,8.57%(3/35)of dizziness and headache,5.71%(2/3

关 键 词：新辅助同步放化疗 食管癌根治术 胸中上段食管癌 细胞免疫 

分 类 号：R735[医药卫生—肿瘤]