乌司他丁在胰腺癌围手术期中的临床研究

Clinical study of the role of ulinastatin in perioperative period of pancreatic cancer

目的研究乌司他丁对围手术期胰腺癌患者的胰瘘发生率、炎性介质水平、免疫功能和预后的影响。方法选取上海交通大学附属第一人民医院普通外科2015年3月-2017年12月收治的胰腺癌患者90例,通过分层随机的方式将围手术期患者分为乌司他丁A组、乌司他丁B组和对照组,每组30例。乌司他丁A组术前5 d和术后5 d给予乌司他丁治疗,B组术前3 d和术后3 d采用乌司他丁治疗,对照组采用术前3 d和术后3 d生理盐水治疗。比较3组患者术后7 d腹腔液引流量、引流液淀粉酶含量、炎性介质、免疫指标及预后情况。结果乌司他丁A组和B组的腹腔引流量、引流液淀粉酶含量均较对照组少,差异有统计学意义(均P<0.05),而A组与B组间差异无统计学意义;乌司他丁A组和B组炎性介质水平低于对照组,差异有统计学意义(均P<0.05),而A组与B组间差异无统计学意义;乌司他丁A组与B组CD4^+淋巴细胞占总淋巴细胞、CD4^+/CD8^+淋巴细胞比值均明显高于对照组(均P<0.05),3组间CD3^+、CD8^+占总淋巴细胞差异无统计学意义;乌司他丁A组和B组生存率高于对照组,A组生存率略高于B组,差异无统计学意义。结论乌司他丁可降低围手术期胰腺癌患者胰液的渗出及胰瘘的发生率,有效改善患者预后的生存率。

Objective To study the effects of Ulinastatin on the incidence of pancreatic fistula, levels of inflammatory mediators, immune function and prognosis in patients with pancreatic cancer during perioperative period. Methods A total of 90 patients with pancreatic cancer admitted to our hospital from March 2015 to December 2017 were enrolled and divided into Ulinastatin group A, Ulinastatin group B and control group according to the perioperative management plan, with 30 cases in each group. Ulinastatin was given to Ulinastatin group A for 5 days before and after the surgery. Group B was treated with Ulinastatin for 3 days before and after the surgery, while the control group was given for 3 days before and after the surgery. The peritoneal fluid drainage, amylase content of the drainage fluid, inflammatory mediators, immune index and prognosis of patients were compared among the three groups. Results The intraperitoneal drainage and amylase content of Ulinastatin group A and group B were lower than those of the control group, the difference was statistically significant(all P<0.05), but there was no significant difference between group A and group B. The levels of inflammatory mediators in group A and group B were lower than those in the control group(all P<0.05), but there was no significant difference between group A and group B. The ratio of CD4^+ lymphocytes to all lymphocytes and the ratio of CD4^+/CD8^+ lymphocytes in Ulinastatin group A and group B were significantly higher than those in the control group(all P<0.05). There was no significant difference in CD3^+ and CD8^+ among the three groups. The survival rate of Ulinastatin group A and group B was higher than that of the control group. The survival rate of group A was slightly higher than that of group B, which was not statistically significant. Conclusion Ulinastatin can reduce the exudation of pancreatic juice and the incidence of pancreatic fistula in perioperative pancreatic cancer patients, and improve the survival rate and prognosis of patients.