张红亮, 李松岩, 刘帛岩, 许晓蕾, 刘逸尘, 王玉峰, 杜晓辉. 结直肠癌术后患者腹腔热灌注化疗近期临床疗效分析[J]. 解放军医学院学报, 2018, 39(12): 1032-1036,1040. DOI: 10.3969/j.issn.2095-5227.2018.12.002
引用本文: 张红亮, 李松岩, 刘帛岩, 许晓蕾, 刘逸尘, 王玉峰, 杜晓辉. 结直肠癌术后患者腹腔热灌注化疗近期临床疗效分析[J]. 解放军医学院学报, 2018, 39(12): 1032-1036,1040. DOI: 10.3969/j.issn.2095-5227.2018.12.002
ZHANG Hongliang, LI Songyan, LIU Boyan, XU Xiaolei, LIU Yichen, WANG Yufeng, DU Xiaohui. Clinical effectiveness of intraperitoneal hyperthermic perfusion chemotherapy after surgery in patients with colorectal cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2018, 39(12): 1032-1036,1040. DOI: 10.3969/j.issn.2095-5227.2018.12.002
Citation: ZHANG Hongliang, LI Songyan, LIU Boyan, XU Xiaolei, LIU Yichen, WANG Yufeng, DU Xiaohui. Clinical effectiveness of intraperitoneal hyperthermic perfusion chemotherapy after surgery in patients with colorectal cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2018, 39(12): 1032-1036,1040. DOI: 10.3969/j.issn.2095-5227.2018.12.002

结直肠癌术后患者腹腔热灌注化疗近期临床疗效分析

Clinical effectiveness of intraperitoneal hyperthermic perfusion chemotherapy after surgery in patients with colorectal cancer

  • 摘要: 目的 探讨腹腔热灌注化疗对结直肠癌术后患者免疫功能、肿瘤标记物、围术期相关并发症及治疗期间不良反应的影响。 方法 回顾性分析2016年1月1日- 2017年12月31日解放军总医院普通外科二病区收治的256例结直肠癌患者临床资料,所有患者均接受了腹腔镜根治性手术,术后行腹腔热灌注化疗联合静脉化疗(联合组)112例,单纯行静脉化疗(化疗组)144例。比较两组患者术前术后TNF-α、CRP、IL-6水平,治疗前后T淋巴细胞比例、肿瘤标记物,围术期相关并发症、治疗期间不良反应,术后半年局部复发、远处转移及生存情况。 结果 两组患者基线资料差异无统计学意义。术后1 d TNF-α(62.86±9.13) ng/L vs (66.42±11.72) ng/L、CRP(46.47±7.58) ng/L vs (49.31±10.03) ng/L、IL-6(40.27±8.36) ng/L vs(43.29±9.66) ng/L联合组低于化疗组(P均< 0.05)。4周期化疗后CD3+、CD4+ T淋巴细胞以及CD4+/CD8+比值联合组均高于化疗组(CD3+,71.83%±8.61% vs 68.77%±9.18%;CD4+,31.64%±4.83% vs 30.01%±5.06%;CD4+/CD8+,1.17%±0.15% vs 1.10%±0.19%;P均< 0.05)。两组手术并发症、化疗不良反应差异无统计学意义。术后半年局部复发联合组低于化疗组(0 vs 5.6%,P< 0.05),两组远处转移及生存情况差异无统计学意义。 结论 腹腔热灌注化疗联合静脉化疗相较于单纯静脉化疗,能够减少术后炎性因子的释放,有助于改善结直肠癌术后患者的免疫功能,减少肿瘤的局部复发,同时不增加围术期相关并发症及化疗期间不良反应。

     

    Abstract: Objective To investigate the effects of intraperitoneal hyperthermic perfusion chemotherapy on immune function, tumor markers, perioperative complications and side effects in patients with colorectal cancer after operation. Methods Clinical data about 256 cases with colorectal cancer who received anterior resection from January 1, 2016 to December 31, 2017 were retrospectively analyzed. Of the 256 cases, 112 patients who received intraperitoneal hyperthermic perfusion chemotherapy combined with intravenous chemotherapy after operation were defined as the combinative treatment group and 144 patients who received intravenous chemotherapy alone as the chemotherapy group. The levels of inf l ammatory factors, T lymphocyte ratio, tumor markers, perioperative complications and side effects were compared between the two groups. Results The baseline data were well matched in two groups (all P< 0.05). At 1 day after surgery, TNF-α, CRP, IL-6 in the combinative treatment group were significantly lower than those in the chemotherapy group TNF, (62.86±9.13) ng/L vs (66.42±11.72) ng/L; CRP, (46.47±7.58) ng/L vs (49.31±10.03) ng/L; IL-6, (40.27±8.36) ng/L vs (43.29±9.66) ng/L; all P< 0.05. The percentages of CD3+, CD4+ T lymphocyte and ratio of CD4+ to CD8+ in the combinative treatment group were higher than those in the chemotherapy group after 4 cycles of chemotherapyCD3+, (71.83%±8.61%) vs (68.77%±9.18%); CD4+, (31.64%±4.83%) vs (30.01%±5.06%); CD3+/CD4+, (1.17%±0.15%) vs(1.10%±0.19%), all P< 0.05. There was no significant difference in complications (anastomotic leakage, incision infection, intra-abdominal hemorrhage, intestinal obstruction), the incidence of myelosuppression, vomiting, diarrhea, oral mucositis after chemotherapy and distant metastasis and survival between the two groups (all P> 0.05). Local recurrence in combinative treatment group was lower than that in chemotherapy group (0 vs 5.6%, P< 0.05). Conclusion Compared with intravenous chemotherapy alone, intraperitoneal hyperthermic perfusion chemotherapy combined with intravenous chemotherapy can reduce the release of inf l ammatory factors, improve the immune function of patients with colorectal cancer, reduce local recurrence of tumor, and it does not increase perioperative complications and adverse reactions during chemotherapy.

     

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