腹腔镜消化道肿瘤根治性术及腔内热灌注化疗联合术后生物免疫治疗对消化道肿瘤患者安全性和生活质量的影响

Effects of laparoscopic radical resection of digestive tract tumors and intracavitary hyperthermic perfusion chemotherapy combined with postoperative biological immunotherapy on safety and quality of life of patients with digestive tract tumors

目的探索腹腔镜消化道肿瘤根治性术及腔内热灌注化疗联合术后生物免疫治疗对消化道肿瘤患者安全性和生活质量的影响。方法前瞻性选取2016年1月至2018年12月邯郸市中心医院收治的102例消化道肿瘤患者,所有患者均行肿瘤根治术,依据随机数字表法,将患者分成观察组和对照组,均为51例。对照组患者术中应用恒温热灌注化疗法,而观察组患者在对照组基础上联合生物免疫疗法。对比和分析2组患者肿瘤标志物、免疫功能、临床疗效、生活质量、生存率及不良反应等参数。结果治疗前,2组患者血清癌胚抗原(CEA)和糖链抗原19-9(CA19-9)水平比较,差异均无统计学意义(P>0.05);治疗后,观察组患者血清CEA和CA19-9水平为(8.01±1.02)μg/L、(30.23±5.01)U/mL,明显低于对照组[(34.01±6.01)μg/L、(86.43±7.01)U/mL],差异均有统计学意义(P<0.05)。治疗前,2组患者CD3+、CD4+、CD4+/CD8+和NK含量比较,差异均无统计学意义(P>0.05);治疗后,观察组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)和NK含量分别为(69.38±2.98)%、(32.64±5.09)%、1.72±0.42、(18.58±3.01)%,显著高于对照组[(56.40±3.10)%、(24.42±3.87)%、1.09±0.51、(11.05±3.51)%],差异均有统计学意义(P<0.05)。观察组患者临床总有效率为86.27%,明显高于对照组的66.67%,差异有统计学意义(P<0.05)。治疗前,2组患者生活质量评分比较,差异无统计学意义(P>0.05);治疗后,观察组患者生活质量评分为(7.44±1.12)分,显著高于对照组[(5.77±1.03)分],差异有统计学意义(P<0.05)。在手术、化疗及免疫疗法等治疗期间,2组患者均出现恶心呕吐、白细胞减少、放射性肠炎和放射性膀胱炎等不良反应事件,但2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。随访3年,所有患者均获得随访,观察组患者3年生存期为78.43%,对照组患者3年生存期为70.59%,差异无统计学意义(P>0.05)。结论术后生物免疫疗法联合根治术和热灌注化疗可有效降低肿瘤标志物指标表达,提高免疫功能,增强临床总有效率,优化生活质量,安全有效,值得临床进一步推广和研究。

Objective To explore the effects of laparoscopic radical resection of digestive tract tumors and intracavitary hyperthermic perfusion chemotherapy combined with postoperative biological immunotherapy on safety and quality of life in patients with digestive tract tumors.Methods A total of 102 patients with digestive tract tumors admitted to Handan Central Hospital from January 2016 to December 2018 were prospectively selected.All patients underwent radical tumor resection,the patients were divided into observation group(n=51)and control group(n=51)according to the method of random number table.The patients in the control group were treated with constant temperature hyperthermic perfusion therapy,while the patients in the observation group were treated with biological immunotherapy on the basis of the control group.The parameters of tumor markers,immune function,clinical efficacy,quality of life,survival rate and adverse reactions were compared and analyzed between the two groups.Results Before treatment,there was no significant difference in serum carcinoembryonic antigen(CEA)and chain antigen 19-9(CA19-9)between the two groups of patients(P>0.05);The levels of serum CEA and CA19-9 in the observation group were(8.01±1.02)μg/L,(30.23±5.01)U/mL,which were significantly lower than those in the control group[(34.01±6.01)μg/L,(86.43±7.01)U/mL],the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in the contents of CD3^(+),CD4^(+),CD4^(+)/CD8^(+) and NK between the two groups of patients(P>0.05);after treatment,the contents of CD3^(+),CD4^(+),CD4^(+)/CD8^(+) and NK in the observation group were(69.38±2.98)%,(32.64±5.09)%,1.72±0.42,(18.58±3.01)%,which were significantly higher than those in the control group[(56.40±3.10)%,(24.42±3.87)%,1.09±0.51,(11.05±3.51)%],the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the quality of life score between the two groups(P>0.05);after treatment,the quality of life scores of the observation group were(7.44±1.12)points,which were significantly higher than those in the control group[(5.77±1.03)points],the differences were statistically significant(P<0.05).During the treatment,adverse reactions such as nausea and vomiting,leukopenia,radiation enteritis and radiation cystitis occurred in both groups,however,there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients(P>0.05).During the 3-year follow-up,all patients were followed up.The 3-year survival time of patients in the observation group was 78.43%,while the control group was 70.59%,there was no statistically significant difference in the 3-year survival time between the two groups(P>0.05).Conclusion Postoperative biological immunotherapy combined with radical resection and hyperthermic perfusion chemotherapy can effectively reduce the expression of tumor markers,improve immune function,enhance clinical total effective rate,optimize quality of life,it is safe and effective,which is worthy of further clinical promotion and research.