低位直肠癌保肛手术治疗直肠癌对TNF-α、IL-2与T淋巴细胞亚群的影响

The clinical efficacy and changes of TNF⁃α,IL⁃2 and T lymphocyte subsets in patients with low rectal cancer treated with anal preserving surgery

目的 分析低位直肠癌保肛手术治疗直肠癌肿瘤坏死因子-α(TNF-α)、白介素-2(IL-2)与T淋巴细胞亚群变化。方法 选取2018年3月至2020年2月张家口市第五医院收治的直肠癌患者103例,根据手术方案分为A组(低位直肠癌保肛手术)53例和B组(Miles术式)50例。比较两组手术指标、炎症因子(TNF-α、IL-2)、T淋巴细胞亚群(CD^(3+)、CD^(4+)、CD^(8+))、并发症情况、肿瘤局部复发率、转移率、生存率。结果 A组失血量少于B组,且手术时长、肛门排气时间、术后住院时长及术后肠道恢复时长均短于B组,差异有统计学意义(P<0.05)。术后两组TNF-α水平均上升,IL-2水平均下降,且A组TNF-α水平低于B组,IL-2水平高于B组,差异有统计学意义(P<0.05)。两组术后CD^(3+)、CD^(4+)水平均显著下降,CD^(8+)水平上升,且A组CD^(3+)、CD^(4+)水平高于B组,CD^(8+)水平低于B组,差异有统计学意义(P<0.05)。A组(3.76%)并发症总发生率明显低于B组(16.00%),差异有统计学意义(P<0.05)。A组肿瘤局部复发率、转移率均显著低于B组,3年生存率高于B组,差异有统计学意义(P<0.05)。结论 低位直肠癌保肛手术治疗直肠癌临床疗效良好,术后对TNF-α、IL-2与T淋巴细胞亚群影响小,可显著提高生存率,降低并发症发生率。

Objective To analyze the changes of tumor necrosis factor-α(TNF-α),interleukin-2(IL-2)and T lymphocyte subsets in rectal cancer treated by anal preserving operation for low rectal cancer.Methods 103 rectal cancer patients admitted to Zhangjiakou Fifth Hospital from March 2018 to February 2020 were selected and divided into group A(low rectal cancer preserving surgery)with 53 cases and group B(Miles surgery)with 50 cases according to the surgical plan.Operative indicators,inflammatory factors[Tumor necrosis factor-alpha(TNF-alpha)],Interleukin-2(interleukin-2)between the two groups IL-2)],T lymphocyte subsets[CD^(3+),CD^(4+),CD^(8+)],complications,local recurrence rate,metastasis rate,survival rate were compared.Results The blood loss in group A was less than that in group B,and the operation time,anal exhaust time,postoperative hospitalization time and postoperative intestinal recovery time were all shorter than those in group B,with statistical significance(P<0.05).After surgery,the level of TNF-αincreased and IL-2 decreased in both groups,and the level of TNF-αin group A was lower than that in group B,while the level of IL-2 was higher than that in group B,the difference was statistically significant(P<0.05).The levels of CD^(3+)and CD^(4+)in both groups were significantly decreased after surgery,while the levels of CD^(8+)were increased,and the levels of CD^(3+)and CD^(4+)in group A were higher than those in group B,while the levels of CD^(8+)were lower than those in group B,with statistical significance(P<0.05).The total complication rate of group A(3.76%)was significantly lower than that of group B(16.00%),and the difference was statistically significant(P<0.05).The local recurrence rate and metastasis rate of group A were significantly lower than those of group B,and the 3-year survival rate was higher than that of group B,the difference was statistically significant(P<0.05).Conclusion Anal preservation surgery for low rectal cancer has a good clinical efficacy,and there was little effect on TNF-α,IL-2 and T lymphocyte subsets after operation.which can significantly improve the survival rate and reduce the incidence of complications and is worthy of clinical priority selection and active promotion.