CAJ | 학술논문

目的探讨术中腹腔氟尿嘧啶(5-FU)缓释剂不同留置方式对胃肠道恶性肿瘤患者腹腔药物浓度、术后并发症发生率及炎症和免疫指标的影响.方法将45例拟行开腹胃癌或结直肠癌根治性手术患者,按随机数字表法随机分为游离播撒组(15例)、固定留置组(15例)和对照组(14例)(1例不符合入组标准而剔除).关腹前游离播撒组根据肿瘤部位将5-FU缓释剂600 mg均匀播散于肿瘤切除创面至系膜根部淋巴结清扫创面；固定留置组除均匀播撒相同剂量的5-FU缓释剂外,在化疗粒子表面喷洒生物蛋白胶并加盖胶原蛋白海绵固定；对照组仅在创面喷洒生物蛋白胶并加盖胶原蛋白海绵覆盖.术前及术后第1、4、7、10天检测3组患者的血常规、肝肾功能、血清C反应蛋白(CRP)、白细胞介素6(IL-6)、T细胞亚群.术后第1、2、4、7天留取血液及腹腔引流液标本,检测5-FU血药浓度和组织液浓度.记录各组术后并发症.结果游离播撒组和固定留置组5-FU血药浓度均未达到高效液相色谱检测值下限.术后第4天,固定留置组患者血清CRP水平低于对照组[(60±29) mg/L比(110±61) mg/L,P＜0.05]；术后各时间点3组血清IL-6水平差异无统计学意义(P＞0.05)；术后第1天,游离播撒组患者CD3+和CD4+细胞低于对照组[分别为(47±11)％比(60±13)％和(23±6)％比(34±13)％,P＜0.05].3组患者术后并发症发生率差异无统计学意义(P＞0.05).结论不同留置方式的5-FU缓释剂对患者术后腹腔引流液5-FU药物浓度无明显影响,腹腔内可维持高浓度5-FU超过7d;缓释化疗药物并未增加胃肠道癌术后并发症发生率；固定留置方式对机体炎症和免疫功能影响更小,具有较好的安全性.
목적 탐토술중복강불뇨밀정(5-FU)완석제불동류치방식대위장도악성종류환자복강약물농도、술후병발증발생솔급염증화면역지표적영향.방법 장45례의행개복위암혹결직장암근치성수술환자,안수궤수자표법수궤분위유리파살조(15례)、고정류치조(15례)화대조조(14례)(1례불부합입조표준이척제).관복전유리파살조근거종류부위장5-FU완석제600 mg균균파산우종류절제창면지계막근부림파결청소창면；고정류치조제균균파살상동제량적5-FU완석제외,재화료입자표면분쇄생물단백효병가개효원단백해면고정；대조조부재창면분쇄생물단백효병가개효원단백해면복개.술전급술후제1、4、7、10천검측3조환자적혈상규、간신공능、혈청C반응단백(CRP)、백세포개소6(IL-6)、T세포아군.술후제1、2、4、7천류취혈액급복강인류액표본,검측5-FU혈약농도화조직액농도.기록각조술후병발증.결과 유리파살조화고정류치조5-FU혈약농도균미체도고효액상색보검측치하한.술후제4천,고정류치조환자혈청CRP수평저우대조조[(60±29) mg/L비(110±61) mg/L,P＜0.05]；술후각시간점3조혈청IL-6수평차이무통계학의의(P＞0.05)；술후제1천,유리파살조환자CD3+화CD4+세포저우대조조[분별위(47±11)％비(60±13)％화(23±6)％비(34±13)％,P＜0.05].3조환자술후병발증발생솔차이무통계학의의(P＞0.05).결론 불동류치방식적5-FU완석제대환자술후복강인류액5-FU약물농도무명현영향,복강내가유지고농도5-FU초과7d;완석화료약물병미증가위장도암술후병발증발생솔；고정류치방식대궤체염증화면역공능영향경소,구유교호적안전성.
Objective To observe the change in the 5-fluorouracil (5-FU) concentration of abdominal cavity,rate of postoperative complications and immunomodulations of the patients with gastric or colorectal cancer after intra-abdominal implantation of sustained-releasing 5-FU.Methods Forty-five selected patients who underwent open radical gastroenterological surgery were randomly divided into 3 groups (dissociated implantation group,fixed implantation group,or reference group) at the ratio of 1∶ 1∶1 according to the random number table.Routine blood test,biochemistry,systemic levels of C reactive protein (CRP) and interleukin 6 (IL-6),percentage of CD3+,CD4+,and CD8+ lymphocytes were evaluated preoperatively and on postoperative dl,d4,d7 and d10.5-FU concentration of blood or abdominal cavity drainage samples was evaluated on postoperative d1,d2,d4 and d7.Occurrence of postoperative complications was evaluated.Results The blood 5-FU concentration was below 100 ng/ml and undetectable by high performance liquid chromatography assay in both experimental groups.No differences between the 3 groups were noticed in serum levels of IL-6 on postoperative days.CRP serum levels of patients in fixed implantation group were lower than those of reference group on postoperative d4 [(60 ± 29) mg/L vs (110 ± 61) mg/L,P ＜0.05].Compared with those of reference group on postoperative dl,percentage of CD3+ and CD4+ lymphocytes was significantly depressed in the dissociated implantation group[(47 ± 11)％ vs (60 ± 13)％ and (23 ± 6)％ vs (34 ± 13) ％,respectively,P ＜ 0.05].Conclusions Different methods of intra-abdominal implantation of sustained-releasing 5-FU during radical surgery of gastrointestinal cancer has little effect on 5-FU concentrations of abdominal cavity.Maintenance of high level of 5-FU in the abdominal cavity can be obtained more than 7 days.Implantation of sustained-releasing 5-FU did not increase the rate of postoperative complications,and had negligible influence on routing blood test and liver and kidney functions.In consideration of the change of immunomodulation and inflammation parameters,fixed implantation of sustained-releasing 5-FU was preferred method of intra-peritoneal chemotherapy.