新辅助化疗联合腹腔镜辅助远端胃癌根治术对进展期远端胃癌患者血清肿瘤标志物水平的影响

The effect of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for distal gastric cancer on the levels of serum tumor markers in the patients with progressive stage distal gastric cancer

目的探讨新辅助化疗联合腹腔镜辅助远端胃癌根治术对进展期远端胃癌患者血清肿瘤标志物水平的影响。方法采用回顾性队列研究方法,选择2017年3月~2019年6月泉州市第一医院收治的83例进展期远端胃癌患者为研究对象,44例新辅助化疗联合腹腔镜辅助远端胃癌根治术为观察组,39例仅接受腹腔镜下远端胃癌根治术,不接受新辅助化疗为对照组,对两组手术根治率及血清肿瘤标志物水平进行比较。结果对照组手术时间为(213.96±31.27)min、术中出血量为(150.37±28.60)mL、淋巴结清扫数目为(21.97±4.69)个,与观察组手术时间为(201.57±31.97)min、术中出血量为(139.38±28.57)mL、淋巴结清扫数目为(22.17±4.57)个比较,差异无统计学意义(P>0.05);治疗前观察组癌胚抗原(CEA)为(9.79±1.98)ngm/L、甲胎蛋白(AFP)为(12.07±2.87)ng/mL、糖类抗原199为(CA199)(34.93±6.41)U/mL、神经元特异性烯醇化酶(NSE)为(14.09±3.98)μg/L,与对照组CEA为(9.78±1.97)ngm/L、AFP为(12.04±2.69)ng/mL、CA199为(34.92±5.42)U/mL、NSE为(12.04±2.69)μg/L比较,差异无统计学意义(P>0.05)。观察组治疗后CEA为(2.48±0.39)ngm/L、AFP为(5.49±1.03)ng/mL、CA199为(12.09±3.24)U/mL、NSE为(5.34±0.51)μg/L,对照组治疗后为CEA(4.61±0.93)ngm/L、AFP为(8.68±1.82)ng/mL、CA199为(21.84±4.06)U/mL、NSE为(9.85±1.92)μg/L比较,观察组血清肿瘤标志物水平均低于对照组(P<0.05);观察组根治性切除率为90.91%,明显高于对照组的74.36%,差异有统计学意义(P<0.05)。结论新辅助化疗联合腹腔镜辅助远端胃癌根治术对进展期远端胃癌效果满意,可有效降低血清肿瘤标志物水平,提高根治性切除率,值得推广。

Objective To explore the effect of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for distal gastric cancer on the levels of serum tumor markers in the patients with progressive stage distal gastric cancer.Methods A method of retrospective cohort study was adopted.From March 2017 to June 2019,83 patients with progressive stage distal gastric cancer admitted to and treated in Quanzhou First Hospital were selected as the subjects of research,with 44 patients who received neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for distal gastric cancer being taken as the observation group,and 39 patients who only received laparoscopic radical gastrectomy for distal gastric cancer without neoadjuvant chemotherapy being taken as the control group.The radical cure rate of operation and serum tumor markers were compared between the two groups.Results The operation time of the control group was(213.96±31.27)min,the intraoperative blood loss was(150.37±28.60)mL,the lymph node dissection number was(21.97±4.69),which showed no significant differences from the(201.57±31.97)min,(139.38±28.57)mL and(22.17±4.57)of the observation group(P>0.05).Before treatment,the carcinoembryonic antigen(CEA)of the observation group was(9.79±1.98)ngm/L,the alpha-fetoprotein(AFP)was(12.07±2.87)ng/mL,the carbohydrate antigen 199(CA199)was(34.93±6.41)U/mL,the neuron specific enolase(NSE)was(14.09±3.98)μg/L,which showed no significant differences from the(9.78±1.97)ngm/L,the(12.04±2.69)ng/mL,(34.92±5.42)U/mL and the(9.85±1.92)μg/L of the control group(P>0.05).After treatment,the CEA of the observation group was(2.48±0.39)ngm/L,the AFP was(5.49±1.03)ng/mL,the CA199 was(12.09±3.24)U/mL,the NSE was(5.34±0.51)μg/L,while after treatment,the CEA of the control group was(4.61±0.93) ngm/L, the AFP was(8.68±1.82) ng/mL, the CA199 was(21.84±4.06) U/mL and the NSE was(9.85±1.92) μg/L, and when compared, the levels of serum tumor markers in the observation group were all superior to those in the control group(P<0.05). The rate of radical resection in the observation group was 90.91%, significantly higher than the 74.36 % in the control group(P<0.05). Conclusion Neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for distal gastric cancer produces satisfactory effect on progressive stage distal gastric cancer. It can effectively reduce the levels of serum tumor markers and improve the rate of radical resection. It is worthy of promotion.