术中雷替曲塞腹腔灌洗在结直肠癌根治术后预防复发的效果

Effect of intra-operative peritoneal lavage with Raltitrexed on preventing recurrence after radical resection of colorectal carcinoma

目的探讨术中雷替曲塞腹腔灌洗在结直肠癌根治术后预防复发的效果及对肿瘤标志物水平的影响。方法收集2015年1月至12月自贡市第一人民医院收治的64例T4大肠癌患者随机分为实验组和对照组(各32例)。两组患者皆行结直肠癌根治术,对照组患者术中以生理盐水灌注腹腔,实验组患者术中则以雷替曲塞腹腔灌洗,比较两组患者治疗前后肿瘤标志物、毒性指标、相关临床指标以及1年复发转移、生存率、术后不良反应率。结果治疗后,实验组患者血管内皮生长因子(VEGF)[(324.40±66.73)pg/ml vs(420.76±34.92)pg/ml]、骨桥蛋白(OPN)[(57.12±16.35)ng/ml vs(80.20±21.35)ng/ml]、癌胚抗原(CEA)[(3.18±1.04)ng/ml vs(5.84±1.80)ng/ml]与糖类抗原199(CA199)[(4.16±2.15)μg/ml vs(8.33±3.47)μg/ml]水平均显著低于对照组(P均<0.01),1年复发转移率明显低于对照组(6.25%vs 25.00%,χ2=4.267,P=0.039)。结论术中雷替曲塞腹腔灌洗在结直肠癌根治术后预防复发的效果显著,可明显降低患者血清VEGF、OPN、CEA及CA199水平,降低1年复发转移率。

Objective To investigate the effect of intra-operative peritoneal lavage with Raltitrexed on preventing recurrence and the level of tumor markers after radical resection of colorectal carcinoma. Methods A total of 64 T4 colorectal carcinoma patients who were treated in Zigong First People＇s Hospital from January 2015 to December 2015 were divided into experimental group and control group randomly（32 cases each）. Both groups were treated with radical resection of colorectal carcinoma. In the control group,patients were received intra-operative peritoneal lavage with saline,and the patients in the experimental group were treated with Raltitrexed instead. The pre-and post-operative level of tumor markers,toxic indicators and related clinical indicators,recurrence and survival after 1 year and rate of postoperative adverse reactions were compared between the two groups. Results The postoperative level of vascular endothelial growth factor（VEGF）,osteopontin（OPN）,carcino-embryonic antigen（CEA） and carbohydrate antigen（CA）-199 in experimental group were all lower than those in control group [（324. 40 ± 66. 73） pg/ml vs（420. 76 ± 34. 92） pg/ml,（57. 12 ± 16. 35） ng/ml vs（80. 20 ± 21. 35） ng/ml,（3. 18 ± 1. 04） ng/ml vs（5. 84 ± 1. 80） ng/ml,（4. 16 ± 2. 15） μg/ml vs（8. 33 ± 3. 47） μg/ml,all P〈0. 05]. The rate of recurrence in experimental group was lower than that in control group（6. 25% vs 25. 00%,χ2= 4. 267,P = 0. 039）. Conclusion Using Raltitrexed in intra-operative peritoneal lavage has a significant effect on preventing recurrence after radical resection of colorectal carcinoma,which could decrease the levels of serum VEGF,OPN,CEA and CA-199 and one-year recurrence rate.