保脾术式对胰体尾癌患者细胞免疫功能及预后的影响

The Effects of Spleen-preserving on Cell Immune Function and Prognosis in Patients with Carcinoma of Body and Tail of Pancreas

目的探讨保脾术式对胰体尾癌患者细胞免疫功能及预后的影响。方法比较保留脾脏与切除脾脏的胰体尾癌术式的手术出血量、并发症发生率、患者细胞免疫功能、生存期。结果保脾组的术中出血量(240±70)ml明显少于切脾组(610±120)ml(t=-12.132,P=0.000);保脾组发生并发症2例,切脾组发生并发症6例,但2组并发症发生率无统计学差别(2χ=1.586,P=0.208)。保脾组中位生存期29.1月,切脾组中位生存期为22.4月,2组有统计学差异(2χ=3.942,P=0.043)。术后14 d保脾组CD3、CD4+显著高于切脾组[(61.08±4.80)%vs(56.03±2.56)%,t=4.172,P=0.000;(31.11±2.63)%vs(28.32±2.22)%,t=3.675,P=0.000],CD4+/CD8+、CD8+2组无统计学差异[(24.10±1.93)%vs(25.12±1.36)%,t=-1.909,P=0.064;(1.32±0.85)%vs(1.12±0.65)%,t=0.843,P=0.404]。结论保留脾脏的胰体尾切除术出血量少,术后患者免疫功能改善明显,生存期满意,适用于脾脏及脾动、静脉未受侵的胰体尾癌患者。

Objective To evaluate the effects of spleen-preserving on cell immune function and prognosis in patients with carcinoma of body and tail of pancreas. Methods The operative blood loss, incidence of complication, cell immune function and survival time were compared between the Spleen-preserving Group and the Spleen Resection Group. Results The blood loss in the Spleen-preserving Group （240 ±70） ml was significantly less than that in the Spleen Resection Group（610 ± 120） ml（t = 12. 132, P =0. 000）. There was no statistic difference in the incidence of complication in the two groups（9.5% vs 30.0% , Χ^2 = 1. 586, P = 0. 208）. The survival time of the Spleen-preserving Group （29. 1 months） was significantly longer than that in the Spleen Resection Group（22.4 months）（ log-rank test, X^2 = 3. 942, P=0. 043 ）. CD3, CD4^＋ in the Spleen-preserving Group were distinctively higher than those in the Spleen Resection Group[ （61.08 ±4.80）% vs （56.03 ±2.56）%, t =4. 172, P=0.000; （31. 11 ±2.63）% vs （28.32±2.22）%, t=3.675, P=0.000], but there was no difference in CD4 ^＋/CD8^＋,CD8^＋ in both groups[（24. 10 ±1.93）% vs （25.12±1.36）%, t= -1.909, P=0.064; （1.32±0.85）% vs （1.12 ±0.65）%, t =0.843, P =0.404]. Conclusions Panereateetomy with spleen-preserving offers the advantages of less blood loss and obvious improvement of postoperative cell immune function, fitting for carcinoma of body and tall of pancreas without infiltration of spleen or major blood vessels.