术后腹腔热灌注化疗对结直肠...、免疫功能及炎性因子的影响_赵鹏.pdf

癌症进展2023 年 3 月第 21 卷第 5 期ONCOLOGY PROGRESS,Mar 2023 V ol.21,No.5*论著*术后腹腔热灌注化疗对结直肠癌患者胃肠功能术后腹腔热灌注化疗对结直肠癌患者胃肠功能、免疫功能免疫功能及炎性因子的影响及炎性因子的影响赵鹏1,2，刘冬2，刘红岗3，杨光2，康艳霞2#1西安市人民医院（西安市第四医院）血液肿瘤中心，西安 710004空军军医大学第二附属医院2肿瘤科，3胸外科，西安 7100380摘要摘要：目的目的探讨术后腹腔热灌注化疗对结直肠癌患者胃肠功能、免疫功能及炎性因子的影响。方法方法根据术后化疗方法的不同将108例腹腔镜结直肠癌根治术患者分为对照组和观察组，每组54例，对照组患者采用静脉化疗，观察组患者采用腹腔热灌注化疗。比较两组患者的胃肠功能指标胃动素（MTL）、胃泌素（GAS）、免疫功能指标（CD4+、CD8+水平及CD4+/CD8+）、炎性因子C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-（TNF-）水平及不良反应发生情况。结果结果化疗后，两组患者的MTL、GAS水平均低于本组化疗前，观察组患者的MTL、GAS水平均高于对照组，差异均有统计学意义（P0.05）。化疗后，两组患者的CD4+水平及CD4+/CD8+均高于本组化疗前，CD8+水平均低于本组化疗前，观察组患者的CD4+水平及CD4+/CD8+均高于对照组，差异均有统计学意义（P0.05）。化疗后，两组患者的CRP、IL-6、TNF-水平均低于本组化疗前，观察组患者的CRP、IL-6、TNF-水平均低于对照组，差异均有统计学意义（P0.05）。两组患者的不良反应总发生率比较，差异无统计学意义（P0.05）。结论结论术后腹腔热灌注化疗可改善结直肠癌患者的胃肠功能和免疫功能，降低炎性因子水平，且具有一定的安全性。关键词关键词：腹腔热灌注化疗；结直肠癌；胃肠功能；免疫功能；炎性因子中图分类号中图分类号：R R735735.3 3文献标志码文献标志码：AdoiAdoi：10.11877/j.issn.1672-1535.2023.21.05.14Effect of postoperative hyperthermic intraperitoneal chemotherapy onEffect of postoperative hyperthermic intraperitoneal chemotherapy ongastrointestinal function,immune function,and inflammatory factorsgastrointestinal function,immune function,and inflammatory factorsin patients with colorectal cancerin patients with colorectal cancerZHAO Peng1,2,LIU Dong2,LIU Honggang3,YANG Guang2,KANG Yanxia2#1Hematology and Oncology Center,Xi an People s Hospital(Xi an Fourth Hospital),Xi an 710004,Shaanxi,China2Department of Oncology,3Department of Thoracic Surgery,the Second Affiliated Hospital of Air Force Military Medical University,Xi an710038,Shaanxi,ChinaAbstract:ObjectiveAbstract:ObjectiveTo investigate the effect of postoperative hyperthermic intraperitoneal chemotherapy on gastro-intestinal function,immune function,and inflammatory factors in patients with colorectal cancer.MethodMethodA total of 108patients with laparoscopic radical resection of colorectal cancer were divided into control group and observation group ac-cording to different postoperative chemotherapy methods,with 54 cases in each group.The patients in the control groupreceived intravenous chemotherapy,and the patients in the observation group received hyperthermic intraperitoneal che-motherapy.The gastrointestinal function indicators motilin(MTL),gastrin(GAS),immune function indicators(CD4+,CD8+levels,and CD4+/CD8+),inflammatory factors C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-(TNF-)levels and adverse events were compared between the two groups.ResultResultAfter the chemotherapy,the levelsof MTL and GAS in the two groups were lower than those before the chemotherapy,and the levels of MTL and GAS inthe observation group were higher than those in the control group,and the differences were statistically significant(P0.05).After the chemotherapy,the levels of CD4+and CD4+/CD8+in the two groups were higher than those before the che-motherapy,and the levels of CD8+were lower than those before the chemotherapy,the CD4+level and CD4+/CD8+in theobservation group were higher than those in the control group,and the differences were statistically significant(P0.05).After the chemotherapy,the levels of CRP,IL-6,and TNF-in the two groups were lower than those before the chemo-therapy,and the levels of the foregoing factors in the observation group were lower than those in the control group,andthe differences were statistically significant(P0.05).ConclusionConclusionPostoperative hyperthermic intraperitoneal chemotherapy couldimprove the gastrointestinal function and immune function of patients with colorectal cancer,and reduce the level of in-flammatory factors with acceptable safety.基金项目：陕西省重点研发计划项目（2019SF-085）#通信作者（corresponding author），邮箱：kyx_521癌症进展2023年3月第21卷第5期Key words:Key words:hyperthermic intraperitoneal chemotherapy;colorectal cancer;gastrointestinal function;immune func-tion;inflammatory factorOncol Prog,2023,21(5)结直肠癌是临床中常见的一种恶性肿瘤，据统计，2020年中国结直肠癌发病例数占全球的28.7%1。近年来结直肠癌的发病率逐渐增加，且其发病年龄趋向年轻化2。结直肠癌的早期诊断率较低，多数患者在确诊时已处于中晚期，手术切除联合全身化疗是转移性或局部晚期结直肠癌的主要治疗手段，既往临床主要采用静脉化疗，但由于存在腹膜-血浆屏障，药物难以进入腹腔内，无法彻底清除肿瘤细胞3。腹腔热灌注化疗是治疗肿瘤的一种新型方法，其通过将化疗药物与热循环技术结合，将化疗药物加热至 4245，通过特定的循环装置在腹腔内循环，杀灭腹膜、肿瘤部位的残存肿瘤细胞或腹腔内游离的肿瘤细胞，达到消灭肿瘤的目的4。研究表明，腹腔热灌注化疗对中晚期腹腔肿瘤具有良好的治疗效果5。基于此，本研究探讨术后腹腔热灌注化疗对结直肠癌患者胃肠功能、免疫功能、炎性因子的影响，现报道如下。1 1资料与方法资料与方法1 1.1 1 一般资料一般资料收集2018年2月至2021年12月西安市人民医院收治的结直肠癌患者的病历资料。纳入标准：经病理检查确诊为结直肠癌；接受腹腔镜结直肠癌根治术；临床资料完整；治疗依从性良好；经影像学检查发现无肝、肺等远处转移。排除标准：凝血功能、免疫功能异常；合并其他恶性肿瘤；合并认知功能障碍，无法正常交流。依据纳入和排除标准，本研究共纳入108例患者。根据术后化疗方法的不同将患者分为对照组和观察组，每组54例，对照组患者采用静脉化疗，观察组患者采用腹腔热灌注化疗。对照组中，男35例，女19例；年龄4876岁，平均（65.798.28）岁；肿瘤位置：结肠26例，直肠28例。观察组中，男33例，女21例；年龄4877岁，平均（66.268.31）岁，肿瘤位置：结肠27例，直肠27例。两组患者的性别、年龄、肿瘤位置比较，差异均无统计学意义（P0.05），具有可比性。本研究经医院伦理委员会审批通过，所有患者均知情同意。1 1.2 2 治疗方法治疗方法两组患者均进行腹腔镜结直肠癌根治术，操作流程按照 腹腔镜结直肠癌根治术操作指南（2018版）6。对照组患者术后2周开始进行静脉化疗。第1天，奥沙利铂200 mg/m2，静脉滴注；第15天，5-氟尿嘧啶 400 mg/m2，亚叶酸钙 300 mg/m2，静脉滴注。21天为1个疗程，共治疗6个疗程。观察组患者术后进行腹腔热灌注化疗。术后第1天使用BR-TRG-体腔热灌注治疗系统进行腹腔热灌注化疗，使用的药物为奥沙利铂和 5-氟尿嘧啶。患者取平卧位，监测心电图。操作过程中将留置于腹壁两侧的体外循环管路与灌注机连接，并启动加热系统和循环泵控制化疗溶液温度为39 左右，总液量在3500 ml以上，流速为300400 ml/min，腹腔内快速灌注。待患者适应后