进展期结直肠癌术后腹腔热灌注化疗对机体免疫功能的影响

Effect of hyperthermic intraperitoneal chemotherapy after laparoscopic radical colorectomy on immune function of patients with progressive colorectal cancer

目的探讨进展期结直肠癌患者手术后腹腔热灌注化疗的安全性及其对机体免疫功能的影响。方法回顾性分析2017年9月1日-2018年6月30日解放军总医院第一医学中心普通外科132例结直肠癌患者的临床资料。所有患者均接受了腹腔镜辅助结直肠癌根治术。其中57例在术后接受了腹腔热灌注化疗(热灌注组),75例仅接受了手术治疗(对照组)。比较两组术前术后炎性因子、T淋巴细胞水平及围术期指标。结果术前两组患者性别、年龄、体质量指数(body mass index,BMI)、ASA分级、肿瘤位置、肿瘤浸润深度、TNM分期及住院期间是否输血等基本资料差异均无统计学意义,TNF-α、CRP、IL-6、淋巴细胞比例均在正常范围值之内,且差异无统计学意义。术后两组炎性因子指标均明显升高,并随着时间逐渐下降。术后第3天和第7天分别行第1次和第3次热灌注治疗后,热灌注组的炎性指标(TNF-α、CRP、IL-6)及CD8+T细胞比例显著高于对照组,CD3^+及CD4^+T细胞比例、CD4^+与CD8^+T细胞比值低于对照组(P均<0.05)。热灌注组的首次排气时间及首次进流食时间长于对照组(P均<0.05)。结论腹腔热灌注化疗会延缓患者术后胃肠功能的恢复,并使外周血炎性因子升高,也会影响患者的免疫状态,对于适应证的把控应当更为严格。

Objective To investigate the safety and effect of hyperthermic intraperitoneal chemotherapy(HIPEC) after laparoscopic radical colorectomy on immune function in patients with progressive colorectal cancer. Methods Clinical data about 132 patients with colorectal cancer in the general surgery department of the first medical center of Chinese PLA General Hospital from September1, 2017 to June 30, 2018 were collected and analyzed retrospectively. All patients underwent laparoscopic radical resection of colorectal cancer, 57 patients received HIPEC after surgery, and 75 patients simply received surgery. The levels of inflammatory cytokines such as TNF-α, CRP, IL-6 and T lymphocytes were measured before and after surgery, and the changes and differences were compared between the two groups. Results There was no statistically significant difference between the two groups in gender,age, BMI, ASA score, primary tumor location, tumor infiltration depth, TNM staging and transfusion(all P >0.05). Before surgery,TNF-alpha, CRP, IL-6 and the proportion of lymphocytes were all within the normal range in two groups, and the differences were not statistically significant(all P >0.05). After the first and third HIPEC at 3 days and 7 days after surgery, the inflammatory cytokines including TNF-α, CRP, IL-6 in HIPEC group were significantly higher than those in control group;the proportion of CD3^+ T cells and the ratio of CD4^+ to CD8^+T cells in HIPEC group were lower than those in control group, and the proportion of CD8^+ T cells in HIPEC group was higher(all P <0.05). The time to first flatus and the time to take first liquid diet in the HIPEC group were greater than those in the control group(P <0.05, respectively). Conclusion After laparoscopic radical resection of colorectal cancer, HIPEC does not increase the incidence of early postoperative complications, but it may delay the recovery of postoperative gastrointestinal function, increase inflammatory cytokines in peripheral blood, and also affect the immune status in patients with progressive colorectal cancer.