老年直肠癌患者低位前切除术中植入5-氟尿嘧啶缓释剂的临床研究

Clinical research of implant of sustained release 5-fluorouracil during low anterior resection of rectal cancer in elderly patients

目的探讨老年直肠癌患者行低位前切除术中植入5-氟尿嘧啶缓释剂的安全性及治疗效果。方法分析2013年1月～2015年6月在北京友谊医院普外科行Dixon术老年直肠癌患者78例临床资料，随机分为两组。实验组43例直肠癌患者行标准根治性手术，术中腹腔内植入缓释性5-氟尿嘧啶：对照组35例，予以单纯根治手术而不植入缓释性5-氟尿嘧啶。术前及术后检测两组患者的白细胞计数、肝肾功能、营养状态指标及免疫功能指标，观察患者住院天数、并发症发生情况。结果两组患者术前白细胞计数（WBC）、肝肾功能、营养与免疫球蛋白指标比较差异无统计学意义（P〉0．05）。实验组术后7d与术前1d比较WBC升高，差异有统计学意义（P〈0．05），对照组WBC术后与术前比较，差异无统计学意义（P〉0．05）；两组患者术后丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血清肌酐（Cr）、血尿素氮（BUN）较术前升高，其中实验组ALT、Cr比较差异有统计学意义（P〈0．05）。术后实验组WBC、A坍、Cr较对照组指标明显升高，差异有统计学意义（P〈0．05）。实验组术后7d与术前1d比较总蛋白（TP）、前白蛋白（PA）、免疫球蛋白A（IgA）明显下降，差异有统计学意义（P〈0．05），对照组术后与术前指标比较，差异无统计学意义（P〉0．05）。实验组术后TP、PA、IgA低于对照组，差异有统计学意义（P〈0．05），其他营养状态指标和免疫球蛋白指标比较差异均无统计学意义（P〉0．05）。术后实验组发热、腹泻发生率较高且腹腔引流量明显多于对照组，差异有统计学意义（P〈0．05）。结论老年直肠癌患者低位前切除术中植入5-氟尿嘧啶缓释剂对患者免疫功能有一定的抑制作用，但未延长术后住院时间，具有较高的安全性，值得临床推广。

Objective To investigate the safety and clinical efficacy of implant of sustained release 5-fluorouracil un- dergoing low anterior resection of rectal cancer in elderly patients. Methods 78 cases of elderly patients with rectal cancer from January 2013 to June 2015 in Beijing Friendship Hospital were randomly divided into experimental group and control group. Sustained release 5-fluorouracil were implant intra-abdominally in 43 patients undergoing low rectal cancer surgery in the experimental group, while 35 cases undergoing radical operation only served as controls. The WBC counting, liver and kidney function, nutrition and immune parameters were detected pre-operatively and post-op- eratively, the days of hospitalization and the occurrence of complications were observed. Results There was no statisti- cally significant difference of WBC counting, liver and kidney function, nutrition and immune parameters of two groups （P 〉 0.05）. Postoperative WBC counting of the experimental group was higher than preoperative, and the difference was statistically significant （P 〈 0.05）. There was no sig- nificant difference of the pre-operatively and post- operatively WBC counting in the control group （P 〉 0.05）. The postoperative ALT, AST, Cr and BUN of two groups were higher than preoperative, and the differences of ALT and Cr in the experimental group were statistically significant （P 〈 0.05）. Postoperative WBC counting, ALT, Cr of the experimental group were signifi- cantly higher than those of the control group （P 〈 0.05）. Postoperative TP, PA and ｜gA levels of the experimental group was higher than preoperative, and the difference was statistically significant （P 〈 0.05）. There was no significant differ- ence of the pre-operatively and post-operatively nutrition and immune parameters in the control group （P 〉 0.05）. Postoperative TP, PA and IgA levels of the experimental group were significantly lower than those of the control group （P 〈 0.05）, and there was no significant difference in other immune parameters （P 〉 0.05）. The incidence rate of fever, diarrhea and abdominal drainage volume in the experimental group were significantly higher than those in the control group （P 〈 0.05）. Conclusion Implant of sustained release 5-fluorouracil during low anterior resection of rectal cancer may inhibit the immune function in elderly patients, but no increase the days of hospitalization, it has high security and is worthy of clinical application.