腹腔镜根治术联合腹腔热灌注化疗治疗进展期直肠癌疗效及对患者血清TK1 COX-2 VEGF水平的影响

Efficacy of Laparoscopic Radical Surgery combined with Intraperitoneal Hyperthermic Perfusion Chemotherapy on Advanced Rectal Cancer and Its Effects on Levels of Serum TK1, COX-2 and VEGF

目的: 探讨腹腔镜根治术联合腹腔热灌注化疗治疗进展期直肠癌疗效及对患者血清胸苷激酶1(TK1)、环氧合酶-2(COX-2)、血管内皮生长因子(VEGF)水平的影响。 方法: 观察我院100例进展期直肠癌患者,单一组43例予以腹腔镜根治术治疗,联合组57例予以腹腔镜根治术联合腹腔热灌注化疗治疗,观察两组治疗效果,并发症发生情况,复发、转移以及生存情况,血清TK1、COX-2、VEGF水平以及身体功能状态情况。 结果: 治疗后,联合组总有效率78.95%显著高于单一组总有效率58.14%,差异有统计学意义(P<0.05);联合组治疗期间吻合口瘘、残端瘘、腹腔感染、肠梗阻、骨髓抑制发生率与单一组比较,差异无统计学意义(P>0.05);联合组复发、转移率显著低于单一组,2年生存率显著高于单一组,差异有统计学意义(P<0.05),联合组无进展生存率显著高于单一组,差异有统计学意义(P<0.05);治疗后,联合组血清TK1、COX-2、VEGF下降幅度大于单一组(P<0.05);KPS组间、时间、交互比较均存在显著差异(P<0.05),术后1年、2年,联合组KPS评分显著低于单一组(P<0.05),两组术后1年、2年KPS评分显著降低(P<0.05)。 结论 :腹腔镜根治术联合腹腔热灌注化疗治疗进展期直肠癌疗效明确,并发症发生率低,有助于降低肿瘤复发、转移率,改善患者生存情况,调节血清TK1、COX-2、VEGF水平,抑制肿瘤细胞增殖,有利于患者身体功能康复。

Objective: To investigate the efficacy of laparoscopic radical surgery combined with intraperitoneal hyperthermic perfusion chemotherapy in the treatment of advanced rectal cancer and its effects on levels of serum thymidine kinase 1 (TK1), cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF). Methods: 100 patients with advanced rectal cancer in our hospital were observed. 43 patients in single group underwent laparoscopic radical surgery, and 57 patients in combined group underwent laparoscopic radical surgery combined with intraperitoneal hyperthermic perfusion chemotherapy. The therapeutic effects, occurrence of complications, recurrence, metastasis and survival, levels of serum TK1, COX-2 and VEGF and physical function status were observed in the two groups. Results: After treatment, the total effective rate in combined group was significantly higher than that in single group (78.95% vs 58.14%) (P<0.05). The incidence rates of anastomotic leakage, stump fistula, abdominal infection, intestinal obstruction and myelosuppression during treatment in combined group were not significantly different from those in single group (P>0.05). The recurrence rate and metastasis rate in combined group were significantly lower than those in single group while the 2-year survival rate was significantly higher than that in single group (P<0.05), and the progression-free survival rate in combined group was significantly higher than that in single group (P<0.05). After treatment, the decreases of serum TK1, COX-2 and VEGF in combined group were greater than those in single group (P<0.05). There were significant differences in the group effects, time effects and interaction effects of KPS (P<0.05), and the KPS scores at 1 year and 2 years after surgery in combined group were significantly higher than those in single group (P<0.05), and the KPS scores in the two groups were significantly increased at 1 year and 2 years after surgery (P<0.05). Conclusion: Laparoscopic radical surgery combined with intraperitoneal hyperthermic perfusion chemotherapy has exact efficacy and low incidence rate of complications in the treatment of advanced rectal cancer, and it can help reduce the tumor recurrence rate and metastasis rate, improve the survival, regulate the levels of serum TK1, COX-2 and VEGF and inhibit tumor cell proliferation, and it is conducive to the recovery of physical function.