新辅助化疗联合腹腔镜治疗进展期胃癌效果及MMP、PG、VEGF水平观察

Effect of neoadjuvant chemotherapy combined with laparoscopy in the treatment of advanced gastric cancer and the expression levels of MMP,PG and VEGF

[目的]探究新辅助化疗联合腹腔镜治疗进展期胃癌的临床效果及对患者预后的影响。[方法]选取2013年12月～2015年1月本院收治的102例进展期胃癌患者作为研究对象,利用随机数字表法分为对照组与观察组,每组各51例。对照组患者采取腹腔镜下胃癌根治术,观察组患者在行腹腔镜下胃癌根治术前先进行新辅助化疗。治疗2个疗程后,比较2组术后疗效及不良反应发生情况;比较2组围术期指标、生活质量情况及手术前后金属蛋白酶、胃蛋白酶原、血管内皮生长因子水平变化;比较2组术后3年生存率。[结果]观察组与对照组根治性切除率分别为为86.3%和70.6%,2组切除率比较差异显著(P<0.05)。2组术后并发症、血液学毒性反应及消化系统毒性反应发生率差异均无统计学意义(P>0.05)。2组手术时间、出血量、淋巴结清扫数目、下床活动时间、肛门排气时间及住院时间等围术期指标均无显著差异(P>0.05)。观察组生活质量恢复总有效率分别为92.2%和80.4%,观察组生活质量恢复情况显著优于对照组(P<0.05)。2组治疗后较治疗前MMP-2、MMP-9、PGⅡ、VEGF-A水平均显著降低(P<0.05),且治疗后观察组较对照组MMP-2、MMP-9、PGⅡ、VEGF-A水平更低(P<0.05)。2组治疗后PGⅠ、VEGF-D水平均显著升高(P<0.05),且治疗后观察组较对照组PGⅠ、VEGF-D水平更高(P <0.05)。对照组3年内生存率均显著低于观察组(P<0.05)。[结论]新辅助化疗联合腹腔镜治疗进展期胃癌疗效显著、安全性较高,有助于患者生活质量的改善,提高患者生存率,且能够调节MMP、PG、VEGF的分泌水平,在进展期胃癌的临床治疗中具有重要意义。

[Objective]To explore the clinical effect of neoadjuvant chemotherapy combined with laparoscopy in the treatment of advanced gastric cancer.[Methods]102patients with advanced gastric cancer admitted to our hospital from December 2013 to January 2015 were enrolled in our study.The patients were randomly divided into the control group and the observation group by random number table method,51 cases in each group.The patients in the control group were treated with laparoscopic radical gastrectomy,and the patients in the observation group were treated with new adjuvant chemotherapy before laparoscopic radical gastrectomy.The effect of two groups after operation and the occurrence of adverse reaction were compared,the indexes of perioperative period,quality of life in two groups and the changes of MMP,PG and VEGF before and after operation were compared.[Results]The radical resection rate of the observation group and the control group was 86.3% and 70.6%respectively.There was significantly difference in the radical resection rate between the observation and control groups(P<0.05).There were no significant difference in the incidence of postoperative complications,hematological toxicity and digestive system toxicity between the two groups(P>0.05).There were no significant difference in operative time,bleeding volume,lymph node dissection,ambulation time,anal exhaust time and hospitalization time between the two groups(P>0.05).The total effective rate of quality of life recovery in the observation group was92.2%and 80.4% respectively.The recovery of quality of life in the observation group was significantly better than that of the control group(P<0.05).After treatment,the levels of MMP-2,MMP-9,PG II and VEGF-A in the two groups were significantly lower than those before treatment(P<0.05),and the levels of MMP-2,MMP-9,PG II and VEGF-A in the observation group were lower than those in the control group(P<0.05).After treatment,the PG I and VEGF-D levels in both groups were increased significantly(P<0.05).The level of PG I and VEGF-D in the observation group was higher than that of the control group after treatment(P<0.05).The survival rate of the control group in three years was significantly lower than that in the observation group(P<0.05).[Conclusion]Neoadjuvant chemotherapy combined with laparoscopic treatment of advanced gastric cancer is effective and safe,which is helpful to improve the quality of life of patients,improve the survival rate of patients,and regulate the secretion of MMP,PG and VEGF.The clinical treatment is of great significance.