术前区域动脉灌注化疗联合腹腔镜手术对Ⅱ、Ⅲ期结直肠癌患者血清生长相关癌基因β及血管生成素样蛋白2表达的影响

Effect of PRAC combined with laparoscopic surgery on the expression of serum GROβ and ANGPTL2 in patients with colorectal cancer

目的探讨术前区域动脉灌注化疗(PRAC)联合腹腔镜手术对Ⅱ、Ⅲ期结直肠癌(CRC)患者血清生长相关癌基因β蛋白(GROβ)及血管生成素样蛋白2(ANGPTL2)表达的影响。方法选择自2015年1月至2017年1月成都市郫都区人民医院收治的Ⅱ、Ⅲ期CRC患者100例,按随机数表分为腹腔镜组(行腹腔镜手术治疗)和联合组(PRAC联合腹腔镜手术治疗),每组50例。另选取同期行开腹手术治疗的Ⅱ、Ⅲ期CRC患者50例,作为对照组。比较三组患者的近期疗效、治疗前后血清GROβ及ANGPTL2蛋白表达水平和术后并发症总发生率。结果 (1)腹腔镜组和联合组切口长度、术中出血量、住院时间均低于对照组,组间比较差异具有统计学意义(t=275.46、3.47、56.15,均P<0.05)。(2)术后腹腔镜组和联合组并发症总发生率分别为14.0%、12.0%,均低于对照组的30.0%,组间比较差异具有统计学意义(χ~2=6.41,P=0.04);但腹腔镜组和联合组术后并发症总发生率比较差异无统计学意义(χ~2=0.09,P=0.77)。(3)与治疗前比较,三组患者术后血清GROβ蛋白水平均升高,ANGPTL2水平均降低,治疗前、术后比较差异具有统计学意义(P<0.05)。术后组间比较,联合组血清GROβ、ANGPTL2蛋白表达水平均低于腹腔镜组和对照组,且腹腔镜组上述指标也低于对照组,组间比较差异均具有统计学意义(P<0.05)。(4)联合组术后癌转移率和复发率分别为6.0%、4.0%,均低于腹腔镜组的22.0%、24.0%和对照组的28.0%、28.0%,差异具有统计学意义(χ~2=8.52、10.89,P=0.014、0.004);但腹腔镜组和对照组的癌转移率和复发率比较,差异无统计学意义。结论术前区域动脉灌注化疗联合腹腔镜手术治疗结直肠癌的近期疗效优于单独腹腔镜手术,且对血清GROβ、ANGPTL2水平的降低效果更佳。

Objective To investigate the expression of growth related oncogene protein serum beta （GROβ） and angiopoietin like protein 2 （ANGPTL2） in the stage Ⅱ, Ⅲ colorectal cancer （CRC） patients with preoperative regional arterial perfusion chemotherapy （PRAC） combined with laparoscopic surgery. Methods From January 2015 to January 2017, one hundred CRC patients of stage Ⅱ, Ⅲin Pidu District People＆#39;s Hospital of Chengdu City were selected. According to the random number table, they were divided into laparoscopic group （laparoscopic surgery） and combined group （PRAC combined with laparoscopic surgery）, with 50 cases in each group. In addition, 50 CRC patients of stage Ⅱ and Ⅲ CRC treated by laparotomy were selected as the control group. The short-term curative effect, the levels of serum GROβ and ANGPTL2 protein and incidence of postoperative complications were compared among the three groups. Results （1） The length of incision, amount of bleeding and length of stay in laparoscopic group and combined group were lower than those in the control group （t=275.46, 3.47, 56.15, all P〈0.05）. （2） The overall complication rate in laparoscopic group and combined group was lower than the control group （14.0%, 12.0%, 30.0%, χ2=6.41, P=0.04）, while there was no significant difference between the laparoscopic group and combined group （χ2=0.09, P=0.77）. （3） Compared to pre-treatment, the levels of serum GROβ were increased, and the levels of ANGPTL2 were decreased in the three groups （P〈0.05）. The levels of serum GROβ and ANGPTL2 in combined group were lower than the laparoscopic group and control group. Similarly, the above indicators in laparoscopic group were lower than those in control group （P〈0.05）. （4） Postoperative metastasis and recurrence rate were 6.0% and 4.0% in combined group, which were lower than the laparoscopic group of 22.0%, 24.0% and control group of 28.0% and 28.0%, the differences were statistically significant （χ2=8.52, 10.89, P=0.014, 0.004）; but no statistical difference was found between the laparoscopic group and control group. Conclusion The short-term curative effect of PRAC combined with laparoscopic surgery for colorectal cancer is better than that of single laparoscopic surgery, and can decrease serum GROβ and ANGPTL2 levels.