脾切除对晚期食管胃结合部癌患者免疫功能及预后的影响

Impact of splenectomy on the prognosis and immune function of patients with end stage carcinoma of the esophagogastric junction

目的探讨联合脾切除对晚期食管胃结合部癌姑息性切除患者免疫功能及预后的影响。方法回顾性分析2007年1月至2010年12月福建医科大学附属第一医院收治的61例晚期食管胃结合部癌患者的临床资料，其中20例因肿瘤侵犯脾脏、2例因术中损伤脾脏行姑息性全胃切除联合脾切除术（脾切除组，22例），其余均行姑息性全胃切除术（脾保留组，39例），分别检测术前、术后10d及术后6个月两组患者免疫功能情况，并比较两组患者术中及术后情况。计量资料采用独立样本t检验，计数资料采用∥检验。结果术后10d，脾切除组IgA、IgG、IgM、CD3、CD4较术前升高，差异有统计学意义（t：2．55，3．33，3．40，2．92，2．10，P〈0．05）；脾保留组IgA、IgG、IgM、CD3、CD4、CD4／CD8较术前升高，差异有统计学意义（t=3．35，5．29，3．33，2．60，3．53，3．12，P〈0．05）。术后6个月，脾切除组IgA、IgG、IgM、CD3、CD4、CD4／CD8较术后10d显著下降，差异有统计学意义（t=2．75，4．40，3．06，2．51，2．24，2．29，P〈0．05）；脾保留组患者IgA、IgG、lgM、CD4、CD8、CD4／CD8优于脾切除组，差异有统计学意义（t=1．70，2．10，2．70，2．16，2．13，2．83，P〈0．05）。脾切除组患者手术时间为（152±26）min，脾保留组为（130±24）min，两组比较，差异有统计学意义（t=3．42，P〈0．05）；脾切除组患者术中出血量、术后感染性并发症发生率高于脾保留组，平均生存时间、1年生存率低于脾保留组，但差异均无统计学意义（t=1．38,X2=0．78，1．22，2．51，P〉0．05）。结论对于不可根治的晚期食管胃结合部癌患者，保留脾脏对其免疫功能及预后可能具有一定的意义。

Objective To investigate the impact of splenectomy on the prognosis and immune function of patients with end stage carcinoma of the esophagogastric. Methods The clinical data of 61 patients with end stage carcinoma of the esophagogastric junction who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2010 were retrospectively analyzed. All the patients were divided into splenectomy group （22 patients） and spleen preservation group （39 patients）. The immune function before operation, on the 10th day and the 6th month after operation was detected. The intra- and postoperative conditions of the patients of the 2 groups were compared. All data were analyzed using the independent sample t test or chi- square test. Results The levels of IgA, IgG, IgM, CD3 and CIM in the splenectomy group at the 10th day after operation were significantly higher than those before operation （t = 2.55, 3.33, 3.40, 2. 92, 2. 10, P 〈 O. 05 ）. The levels of lgA, IgG, IgM, CD3, CD4, the ratio of CD4/CD8 of the spleen preservation group at the 10th day after operation were significantly higher than those before operation （t =3.35, 5.29, 3.33, 2. 60, 3.53, 3.12, P 〈0.05）. The levels of IgA, IgG, IgM, CD3, CD4 and the ratio of CD4/CD8 in the splenectomy group at postoperative month 6 were significantly lower than those at postoperative day 10 （t = 2. 75, 4. 40, 3.06, 2. 51, 2. 24, 2. 29, P 〈 0.05）. The levels of IgA, IgG, IgM, CIM, CD8 and the ratio of CD4/CD8 of the spleen preservation group were significantly higher than those of the splenectomy group, while the level of CD8 in the spleen preservation group was significantly lower than that in the splenectomy group （t = 1.70, 2. 10, 2.70, 2. 16, 2. 13, 2. 83, P 〈 0.05 ）. The operation time of the splenectomy group was （ 152 ± 26） minutes, which wassignificantly longer than （ 130 ± 24） minutes of the spleen preservation group （ t = 3. 42, P 〈 0.05 ）. There were no significant differences in the operative blood loss, incidence of postoperative infection, median survival time, 1 -year survival rate between the 2 groups （t = 1.38, X2=0. 78, 1.22, 2. 51, P 〉 0.05）. Conclusion Palliative gastrecto- my could reverse the immune function of spleen by decreasing tumor burden for patients with end stage carcinoma of the esophagogastric junction who can not be treated by radical resection. Spleen preservation may have positive significance for the immune function and prognosis of patients with end stage carcinoma of the esophagogastric junction.