摘要
目的观察新辅助化疗联合腹腔镜手术治疗进展期胃癌的临床疗效及对患者围手术期免疫功能的影响。方法选取2013年1月至2015年1月收治的进展期胃癌患者110例,随机分为对照组和观察组,每组55例。对照组仅采用腹腔镜手术治疗,观察组在对照组基础上采用术前新辅助化疗。比较2组临床疗效、术后1周患者外周血T淋巴细胞亚群(CD+3、CD+4、CD+8、CD+4/CD+8)、NK细胞活性及免疫球蛋白(Ig A、Ig G、Ig M)变化。术后随访3年,比较2组复发、转移、死亡情况及无瘤生存期、总生存期。结果 (1)观察组有效率和手术切除率分别为76.36%(42/55)、83.64%(46/55),对照组有效率和肿瘤降期率分别为56.36%(31/55)、69.09%(38/55),观察组有效率和肿瘤降期率均显著高于对照组,差异有统计学意义(P<0.05)。2组毒副反应及术后并发症发生率比较差异无统计学意义(P>0.05)。(2)治疗后2组IFN-γ、IL-4、TGF-β、CD+3、CD+4、CD+8、CD+4/CD+8、NK细胞活性及Ig A、Ig G、Ig M均较治疗前有所改善,差异有统计学意义(P<0.05);但观察组改善程度优于对照组,差异有统计学意义(P<0.05)。(3)观察组复发率、转移率及病死率较对照组明显降低,无瘤生存期和总生存期较对照组明显延长,差异有统计学意义(P<0.05)。结论新辅助化疗后行腹腔镜手术能够明显促进患者围手术期机体细胞免疫和体液免疫功能的恢复,降低术后复发率,延长患者生存时间,且毒副反应少,值得临床推广应用。
Objective To observe the clinical efficiency of neoadjuvant chemotherapy combined with laparoscopic surgery on advanced gastric carcinoma and its effects on patient＇s immune function at peroperative period. Methods A total of 110 patients with advanced gastric carcinoma who were admitted into our hospital from January 2013 to January 2015 were randomly divided into observation group（ n = 55） and control group（ n = 55）. The patients in control group were treated by laparoscopic surgery,however,the patients in observation group,on the basis of control group,were treated by preoperative neoadjuvant chemotherapy. After treatment,the clinical curative effects,the changes of CD3^＋,CD4^＋,CD8^＋,CD4^＋/ CD8^＋,NK cells activity,Ig A,Ig G,Ig M were observed and detected in both groups. The patients were followed up for 3 years. The relapse rate,metastasis rate,fatality rate,tumor-free survival time and overall survival time were observed and detected.Results The total effective rates and resective rates in observation group were 76. 36%（ 42 /55） and 83. 64%（ 46 /55）,respectively,which in control group were 56. 36%（ 31 /55）,69. 09%（ 38 /55）,respectively, there were significant differences between two groups（ P〈0. 05）. However there were no significant differences in toxic reactions and incidences of postoperative complications between two groups（ P〈0. 05）. After treatment,the CD＋3,CD＋4,CD＋8,CD＋4/ CD＋8,NK cells activity,Ig A,Ig G,Ig M were obviously improved,as compared with those before treatment in both groups（ P〈0. 05）,moreover,the improvement degree in observation group was more obvious than that in control group（ P〈0. 05）. The relapse rate,metastasis rate and mortality rate in observation group were significantly lower than those of control group,furthermore,the tumor-free survival time and overall survival time in observation group were obviously longer than those of control group（ P〈0. 05）. Conclusion The preoperative neoadjuvant chemotherapy combined with laparoscopic surgery can obviously improve cellular and humoral immune function of patients with advanced gastric cancer at perioperative period,which can reduce postoperative relapse rate and can prolong patient＇s survival time,with less toxic and adverse reactions,thus it is worthy to be widely applied in clinic.
出处
《河北医药》
CAS
2015年第19期2904-2907,共4页
Hebei Medical Journal
关键词
胃癌
进展期
新辅助化疗
腹腔镜手术
T淋巴细胞亚群
免疫球蛋白
gastric cancer
progressive stage
neoadjuvant chemotherapy
laparoscopic surgery
T lymphocyte subsets
immunoglobulin
