胰十二指肠切除手术对胰腺癌患者疗效及细胞免疫功能的影响

Efficacy of pancreaticoduodenectomy in patients with pancreatic cancer and the effect on cellular immune function

目的探讨胰十二指肠切除手术(PD)对胰腺癌患者疗效及细胞免疫功能的影响。方法选取2008年6月至2013年8月间成都三六三医院收治的107例行胰十二指肠切除手术的胰腺癌患者,将采用扩大PD手术的53例患者纳入研究组,将采用标准PD手术的54例患者纳入对照组。比较两组患者的手术指标、T细胞亚群及并发症和术后1年及5年生存率情况。结果研究组患者的手术时间短于对照组患者,阳性淋巴结清扫个数和淋巴结清扫总个数均多于对照组患者,差异均有统计学意义(均P <0. 05)。两组患者术前和术后7d的T细胞亚群水平比较,差异无统计学意义(P> 0. 05);术后14d,两组患者CD4^+、CD8^+和CD4^+/CD8^+水平均较术前及术后7d改善,差异均有统计学意义(均P <0. 05)。术后14d,两组患者CD3^+水平均较术前改善,差异有统计学意义(P <0. 05)。两组患者并发症发生情况比较,差异无统计学意义(P> 0. 05)。研究组患者1年生存率为88. 7%(47/53),对照组1患者年生存率为87. 0%(47/54),组间比较,差异无统计学意义(x^2=0. 07,P=0. 80);研究组患者5年生存率为37. 7%(20/53),明显高于对照组的5. 6%(3/54),组间比较,差异有统计学意义(x^2=16. 41,P <0. 05)。结论 PD及扩大PD均能改善患者免疫功能,且扩大PD能更有效减少胰腺癌患者的手术时间,清除淋巴结,改善预后并预防种瘤转移。

Objective To investigate the efficacy of pancreaticoduodenectomy(PD)in patients with pancreatic cancer and the effect on cellular immune function.Methods From June 2008 to August2013,107 patients with pancreatic cancer undergoing PD Chengdu 363 Hospital were selected.According to the random digital table method,they were divided into a study group(53 patients)and a control group(54 patients).The study group underwent extended PD surgery and the control group underwent standard PD operation.The surgical parameters,T cell subsets,complications and 1-year and 5-year survival rate were observed and recorded in both groups.Results The operative time was significantly shorter in the study group than in the control group(P<0.05).The number of positive lymph node dissection,and the total number of lymph node dissection were significantly higher in the study group than in the control group(P<0.05).There was no significant difference in T cell subsets between the two groups before the surgery and at 7 d after the surgery(P>0.05).At 14 d after the operation,the levels of CD4^+,CD8^+,CD4^+/CD8^+and CD3^+were significantly improved in both groups compared with those before and at 7 d after the operation(all P<0.05).There was no significant difference in complications between the two groups(P>0.05).The 1-year survival was 88.7%(47/53)for the study group and 87.0%(47/54)for the control group(P>0.05).The 5-year survival rate was 37.7%(20/53)in the study group which was higher than5.6%(3/54)in the control group(P<0.05).Conclusion Both PD and expanded PD can improve the immune function of the patients,but the enlargement of PD can effectively reduce the operation time,improve the prognosis and prevent the metastasis of tumors.