区域动脉灌注化疗联合腹腔镜手术在中晚期结直肠癌中的应用效果及对血清肿瘤标志物的影响

The effect of preoperative regional intra-arteral chemotherapy combined with laparoscopic surgery in the treatment of advanced colorectal cancer and its influence on serum tumor markers

目的区域动脉灌注化疗联合腹腔镜手术在中晚期结直肠癌中的应用效果及对患者血清肿瘤标志物的影响。方法依据入院顺序将144例结直肠癌患者分为观察组和对照组,每组72例,对照组患者接受腹腔镜手术治疗,观察组术前接受区域动脉灌注化疗(PRAC)治疗。比较两组患者的一般手术指标;化疗前、术前和术后2周,比较两组患者血清肿瘤标志物水平,包括生长相关基因产物β(GROβ)、血管生成素样蛋白2(ANGPTL2)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9);术后2年,比较两组患者的复发率和生存率。结果两组患者手术时间、术中出血量、切口长度、清扫淋巴结数目、术后肛门首次排气时间和住院时间比较,差异均无统计学意义(P﹥0.05)。术前、术后2周,观察组患者血清GROβ、ANGPTL2、CEA、CA19-9水平均明显低于对照组患者,差异均有统计学意义(P﹤0.01)。两组患者的并发症总发生率和2年生存率比较,差异无统计学意义(P﹥0.05)。随访2年,观察组患者的复发或转移率为25.00%,低于对照组患者的41.67%,差异有统计学意义(P﹤0.05)。结论PRAC联合腹腔镜手术可降低中晚期结直肠癌患者的肿瘤标志物水平,可降低术后复发或转移率,但对患者生存情况的影响并不明显,且不增加手术并发症的发生风险。

Objective To investigate the effect of preoperative regional intra-arteral chemotherapy(PRAC)combined with laparoscopic surgery in the treatment of advanced colorectal cancer.Method 144 cases of colorectal cancer patients were selected and divided into experimental group and the control group according to admission sequence,72 cases in each group.Both groups were treated with laparoscopic surgery,and the experimental group was treated with PRAC before operation.The general operation indexes of the two groups were compared.Before chemotherapy,before operation and 2 weeks after operation,serum tumor markers were compared between the two groups,including growth-related gene productβ(GROβ),angiogenin-like protein 2(ANGPTL2),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9).2 years after operation,the recurrence rate and survival rate of the two groups were compared.Result There was no significant difference in operation time,intraoperative blood loss,incision length,number of lymph node dissection,recovery time of intestinal function and hospitalization time between the experimental group and the control group(P>0.05).Before operation and 2 weeks after operation,the levels of GROβ,ANGPTL2,CEA and CA19-9 in the observation group were significantly lower than those in the control group(P<0.01).There was no significant difference in the total incidence of complications and 2-year survival rate between the two groups(P>0.05).After 2 years of follow-up,the recurrence or metastasis rate of the observation group was 25.00%,which was lower than 41.67%of the control group(P<0.05).Conclusion PRAC combined with laparoscopic surgery in the treatment of advanced colorectal cancer is beneficial to reduce the patient’s tumor markers and reduce the postoperative recurrence or metastasis rate.There was no increase in the risk of complications.The overall impact on patient survival is not obvious.