摘要
目的探讨腹腔镜扩大根治术治疗老年直肠癌的疗效及其对T细胞亚群、自然杀伤T(NKT)细胞的影响。方法选取2009年8月至2012年8月间四川省邛崃市医疗中心医院收治的72例经病理学诊断为直肠癌患者,按照手术方式分为观察组(37例)和对照组(35例)。观察组患者接受腹腔镜扩大根治术,对照组患者接受开腹直肠癌扩大根治术。比较两组患者的临床疗效、围术期血清炎性细胞因子水平、T细胞亚群和NKT细胞水平变化。结果观察组患者有效率(RR)和疾病控制率(DCR)分别为83.8%和91.9%,对照组则分别为62.9%和85.7%,组间差异有统计学意义(P<0.05)。观察组患者手术时间、术中出血量及术后肠道功能恢复时间均显著小于对照组,组间差异有统计学意义(P<0.05)。根据生活质量评价量表(SF-12),观察组患者治疗后生活量表相关维度(总体健康、情感职能、躯体疼痛及精神健康)评分均显著高于对照组,组间差异有统计学意义(P<0.05)。两组患者术后1 d、3 d和5 d血清白介素6(IL-6)、白介素8(IL-8)水平均显著高于术前1 d,差异有统计学意义(P<0.05);观察组患者术后1 d、3 d血清白介素8(IL-8)水平均显著高于术前1 d,差异有统计学意义(P<0.05)。观察组患者术后血清IL-6及IL-8水平均显著低于对照组术后相应时间的水平,组间差异有统计学意义(P<0.05),且观察组患者术后5 d血清IL-8水平又恢复至术前水平,组内差异无统计学意义(P>0.05)。观察组患者手术前后T淋巴细胞亚群各指标(CD3^+T、CD4^+T、CD8^+T及CD4^+/CD8^+T)水平均处于稳定状态,而对照组手术前后上述指标间差异均有统计学意义(P<0.05),且两组患者术后各对应时间点上述指标水平的差异也均有统计学意义(P<0.05)。结论腹腔镜扩大根治术治疗老年直肠癌的疗效显著,且对机体T细胞亚群、NKT细胞的影响较小,值得临床推广。
Objective To evaluate the efficacy of laparoscopic extended radical mastectomy in the treatment of elderly colorectal cancer and influences of T cell subsets and natural killer T （NKT） cells. Methods From August 2009 to August 2012 in Qionglai Medical Center Hospital, 72 cases of pathologically diagnosed with colorectal cancer were divided into the observation group （ n = 37 ） and the control group （n = 35） respectively. The patients in the observation group accepted extended radical laparoscopic surgery and those in the control groupopen colorectal cancer resection. The clinical efficacy, serum levels of inflammatory cytokines, T cell subsets, NKT cell levels between the two groups were compared between the two groups. Results In the observation group, the response rate （RR） and disease control rate （DCR） were 83.8% and 91.9% respectively, and those in the control group were 62. 9% and 85.7%, with significant differences （P 〈 0.05 ）. The operative time, blood loss and postoperative intestinal function recovery time of the observation group were significantly less than those of the control group, with significant differences （P 〈 0. 05）. According to short form 12 questionnaire （SF-12） scale score, after treatment, life scale related dimensions （overall health, emotional function, bodily pain and mental health） scores of all the patients were significantly higher （ P 〈 0. 05）. Postoperative 1 d, 3 d, 5 d, serum interleukin-6 （IL-6） levels were significantly higher than the preoperative 1 d （ P 〈 0. 05 ）. After 1 d, 3 d in the observation group, serum IL-8 levels were significantly higher than the preoperative 1 d （ P 〈 0. 05 ） ; in the control group, serum IL-8 levels of 1 d, 3 d, 5 d were significantly higher than preoperative 1 d （ P 〈 0. 05 ）. Postoperative serum IL-6 and IL-8 of the observation group were significantly lower than those of the control group after corresponding time （ P 〈 0. 05 ）, and postoperative 5 d, serum levels of IL-8 returned to the preoperative level （P 〉 0. 05）. Before and after surgery, T lymphocyte subsets （CD3^＋ T, CD4^＋ T, CD8 ^＋ T and CD4^＋/CD8^＋ T） stayed a stable state, while those in the control group showed statistical significance （P 〈 0. 05 ）. Conclusion For elderly colorectal cancer patients, laparoscopic radical mastectomy coule a- chieve good efficacy. So it is worthy of clinical promotion.
出处
《中国肿瘤临床与康复》
2016年第7期798-802,共5页
Chinese Journal of Clinical Oncology and Rehabilitation
