CAJ | 학술논문

目的探讨联合脾切除对晚期食管胃结合部癌姑息性切除患者免疫功能及预后的影响.方法回顾性分析2007年1月至2010年12月福建医科大学附属第一医院收治的61例晚期食管胃结合部癌患者的临床资料,其中20例因肿瘤侵犯脾脏、2例因术中损伤脾脏行姑息性全胃切除联合脾切除术(脾切除组,22例),其余均行姑息性全胃切除术(脾保留组,39例),分别检测术前、术后10 d及术后6个月两组患者免疫功能情况,并比较两组患者术中及术后情况.计量资料采用独立样本t检验,计数资料采用x2检验.结果术后10d,脾切除组IgA、IgG、IgM、CD3、CD4较术前升高,差异有统计学意义(t=2.55,3.33,3.40,2.92,2.10,P＜0.05)；脾保留组IgA、IgG、IgM、CD3、CD4、CD4/CD8较术前升高,差异有统计学意义(f =3.35,5.29,3.33,2.60,3.53,3.12,P＜0.05).术后6个月,脾切除组IgA、IgG、IgM、CD3、CD4、CD4/CD8较术后10 d显著下降,差异有统计学意义(=2.75,4.40,3.06,2.51,2.24,2.29,P＜0.05)；脾保留组患者IgA、IgG、IgM、CD4、CD8、CD4/CD8优于脾切除组,差异有统计学意义(t=1.70,2.10,2.70,2.16,2.13,2.83,P＜0.05).脾切除组患者手术时间为(152±26) min,脾保留组为(130±24) min,两组比较,差异有统计学意义(t=3.42,P＜0.05)；脾切除组患者术中出血量、术后感染性并发症发生率高于脾保留组,平均生存时间、1年生存率低于脾保留组,但差异均无统计学意义(t=1.38,x2=0.78,1.22,2.51,P＞0.05).结论对于不可根治的晚期食管胃结合部癌患者,保留脾脏对其免疫功能及预后可能具有一定的意义.
목적 탐토연합비절제대만기식관위결합부암고식성절제환자면역공능급예후적영향.방법 회고성분석2007년1월지2010년12월복건의과대학부속제일의원수치적61례만기식관위결합부암환자적림상자료,기중20례인종류침범비장、2례인술중손상비장행고식성전위절제연합비절제술(비절제조,22례),기여균행고식성전위절제술(비보류조,39례),분별검측술전、술후10 d급술후6개월량조환자면역공능정황,병비교량조환자술중급술후정황.계량자료채용독립양본t검험,계수자료채용x2검험.결과 술후10d,비절제조IgA、IgG、IgM、CD3、CD4교술전승고,차이유통계학의의(t=2.55,3.33,3.40,2.92,2.10,P＜0.05)；비보류조IgA、IgG、IgM、CD3、CD4、CD4/CD8교술전승고,차이유통계학의의(f =3.35,5.29,3.33,2.60,3.53,3.12,P＜0.05).술후6개월,비절제조IgA、IgG、IgM、CD3、CD4、CD4/CD8교술후10 d현저하강,차이유통계학의의(=2.75,4.40,3.06,2.51,2.24,2.29,P＜0.05)；비보류조환자IgA、IgG、IgM、CD4、CD8、CD4/CD8우우비절제조,차이유통계학의의(t=1.70,2.10,2.70,2.16,2.13,2.83,P＜0.05).비절제조환자수술시간위(152±26) min,비보류조위(130±24) min,량조비교,차이유통계학의의(t=3.42,P＜0.05)；비절제조환자술중출혈량、술후감염성병발증발생솔고우비보류조,평균생존시간、1년생존솔저우비보류조,단차이균무통계학의의(t=1.38,x2=0.78,1.22,2.51,P＞0.05).결론 대우불가근치적만기식관위결합부암환자,보류비장대기면역공능급예후가능구유일정적의의.
Objective To investigate the impact of splenectomy on the prognosis and immune function of patients with end stage carcinoma of the esophagogastric.Methods The clinical data of 61 patients with end stage carcinoma of the esophagogastric junction who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2010 were retrospectively analyzed.All the patients were divided into splenectomy group (22 patients) and spleen preservation group (39 patients).The immune function before operation,on the 10th day and the 6th month after operation was detected.The intra-and postoperative conditions of the patients of the 2 groups were compared.All data were analyzed using the independent sample t test or chisquare test.Results The levels of IgA,IgG,IgM,CD3 and CD4 in the splenectomy group at the 10th day after operation were significantly higher than those before operation (t =2.55,3.33,3.40,2.92,2.10,P ＜ 0.05).The levels of IgA,IgG,IgM,CD3,CD4,the ratio of CD4/CD8 of the spleen preservation group at the 10th day after operation were significantly higher than those before operation (t =3.35,5.29,3.33,2.60,3.53,3.12,P ＜0.05).The levels of IgA,IgG,IgM,CD3,CD4 and the ratio of CD4/CD8 in the splenectomy group at postoperative month 6 were significantly lower than those at postoperative day 10 (t ＝2.75,4.40,3.06,2.51,2.24,2.29,P ＜ 0.05).The levels of IgA,IgG,IgM,CD4,CD8 and the ratio of CD4/CD8 of the spleen preservation group were significantly higher than those of the splenectomy group,while the level of CD8 in the spleen preservation group was significantly lower than that in the splenectomy group (t =1.70,2.10,2.70,2.16,2.13,2.83,P ＜ 0.05).The operation time of the splenectomy group was (152 ± 26) minutes,which was significantly longer than (130 ± 24) minutes of the spleen preservation group (t ＝ 3.42,P ＜ 0.05).There were no significant differences in the operative blood loss,incidence of postoperative infection,median survival time,1-year survival rate between the 2 groups (t =1.38,x2 =0.78,1.22,2.51,P ＞ 0.05).Conclusion Palliative gastrectomy could reverse the immune function of spleen by decreasing tumor burden for patients with end stage carcinoma of the esophagogastric junction who can not be treated by radical resection.Spleen preservation may have positive significance for the immune function and prognosis of patients with end stage carcinoma of the esophagogastric junction.