中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
6期
854-858
,共5页
赵昕波%游红勇%李兵%陈智敏%刘东涛
趙昕波%遊紅勇%李兵%陳智敏%劉東濤
조흔파%유홍용%리병%진지민%류동도
胃肿瘤%腹腔镜%高敏C反应蛋白%凝血功能%血清肿瘤标志物
胃腫瘤%腹腔鏡%高敏C反應蛋白%凝血功能%血清腫瘤標誌物
위종류%복강경%고민C반응단백%응혈공능%혈청종류표지물
Stomach neoplasms%Laparoscopic%High sensitive C reactive protein%Coagulation function%Tumor biomarker
目的 探讨腹腔镜辅助胃癌根治术治疗老年进展期胃癌的远期临床效果及对血清肿瘤标志物和高敏C反应蛋白(hs-CRP)的影响.方法 选取2008年8月至2012年6月四川省崇州市人民医院诊治的86例进展期胃癌患者,根据手术疗式不同分为腹腔镜组(43例)和传统开腹组(43例),比较2种手术方式的近远期临床效果及血清肿瘤标志物,包括癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白21-1片段(CYFRA21-1)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9),hs-CRP及凝血功能指标的变化情况.结果 腹腔镜组与传统开腹组手术时间和淋巴结清扫数目比较差异无统计学意义(P＞0.05);而出血量[(89±19)ml比(122±25) ml]、止痛剂使用次数[(0.68±0.28)次比(2.19±0.53)次]、胃肠道恢复时间[(2.6±0.4)d比(4.0±0.5)d]、住院时间[(9.1±1.8)d比(12.6±2.4)d]和不良反应发生率[14.0％ (6/43)比39.5％ (17/43)]比较差异均有统计学意义(均P＜0.05),均为腹腔镜组优于传统开腹组.腹腔镜组患者中位总生存期(OS)为10.2个月(95％ CI:8.211～13.089),传统开腹组患者为9.7个月(95％ CI:5.804～ 10.596),组间差异无统计学意义(x2=3.481,P=0.062).手术前2组患者的CEA、NSE、CYFRA21-1、CA125、CA19-9,hs-CRP和凝血功能凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间比较差异均无统计学意义(均P＞0.05),但手术后各项指标均有所改善,而且腹腔镜组患者的降低幅度均明显高于传统开腹组[CEA:(10.1±2.6) μg/L比(18.8±5.2) μg/L;NSE:(14±3) μg/L比(22±7)μg/L;CA125:(31±7)kU/L比(45±7) kU/L;CA19-9:(28±7)kU/L比(47±17)kU/L和hs-CRP:(2.3±0.7) mg/L比(2.9±0.9)mg/L] (P＜0.05).结论 腹腔镜辅助胃癌根治术对老年进展期胃癌有良好的临床效果,并且能明显改善血清肿瘤标志物和hs-CRP水平.
目的 探討腹腔鏡輔助胃癌根治術治療老年進展期胃癌的遠期臨床效果及對血清腫瘤標誌物和高敏C反應蛋白(hs-CRP)的影響.方法 選取2008年8月至2012年6月四川省崇州市人民醫院診治的86例進展期胃癌患者,根據手術療式不同分為腹腔鏡組(43例)和傳統開腹組(43例),比較2種手術方式的近遠期臨床效果及血清腫瘤標誌物,包括癌胚抗原(CEA)、神經元特異性烯醇化酶(NSE)、細胞角蛋白21-1片段(CYFRA21-1)、糖類抗原125(CA125)、糖類抗原19-9(CA19-9),hs-CRP及凝血功能指標的變化情況.結果 腹腔鏡組與傳統開腹組手術時間和淋巴結清掃數目比較差異無統計學意義(P＞0.05);而齣血量[(89±19)ml比(122±25) ml]、止痛劑使用次數[(0.68±0.28)次比(2.19±0.53)次]、胃腸道恢複時間[(2.6±0.4)d比(4.0±0.5)d]、住院時間[(9.1±1.8)d比(12.6±2.4)d]和不良反應髮生率[14.0％ (6/43)比39.5％ (17/43)]比較差異均有統計學意義(均P＜0.05),均為腹腔鏡組優于傳統開腹組.腹腔鏡組患者中位總生存期(OS)為10.2箇月(95％ CI:8.211～13.089),傳統開腹組患者為9.7箇月(95％ CI:5.804～ 10.596),組間差異無統計學意義(x2=3.481,P=0.062).手術前2組患者的CEA、NSE、CYFRA21-1、CA125、CA19-9,hs-CRP和凝血功能凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、纖維蛋白原(FIB)、凝血酶時間比較差異均無統計學意義(均P＞0.05),但手術後各項指標均有所改善,而且腹腔鏡組患者的降低幅度均明顯高于傳統開腹組[CEA:(10.1±2.6) μg/L比(18.8±5.2) μg/L;NSE:(14±3) μg/L比(22±7)μg/L;CA125:(31±7)kU/L比(45±7) kU/L;CA19-9:(28±7)kU/L比(47±17)kU/L和hs-CRP:(2.3±0.7) mg/L比(2.9±0.9)mg/L] (P＜0.05).結論 腹腔鏡輔助胃癌根治術對老年進展期胃癌有良好的臨床效果,併且能明顯改善血清腫瘤標誌物和hs-CRP水平.
목적 탐토복강경보조위암근치술치료노년진전기위암적원기림상효과급대혈청종류표지물화고민C반응단백(hs-CRP)적영향.방법 선취2008년8월지2012년6월사천성숭주시인민의원진치적86례진전기위암환자,근거수술료식불동분위복강경조(43례)화전통개복조(43례),비교2충수술방식적근원기림상효과급혈청종류표지물,포괄암배항원(CEA)、신경원특이성희순화매(NSE)、세포각단백21-1편단(CYFRA21-1)、당류항원125(CA125)、당류항원19-9(CA19-9),hs-CRP급응혈공능지표적변화정황.결과 복강경조여전통개복조수술시간화림파결청소수목비교차이무통계학의의(P＞0.05);이출혈량[(89±19)ml비(122±25) ml]、지통제사용차수[(0.68±0.28)차비(2.19±0.53)차]、위장도회복시간[(2.6±0.4)d비(4.0±0.5)d]、주원시간[(9.1±1.8)d비(12.6±2.4)d]화불량반응발생솔[14.0％ (6/43)비39.5％ (17/43)]비교차이균유통계학의의(균P＜0.05),균위복강경조우우전통개복조.복강경조환자중위총생존기(OS)위10.2개월(95％ CI:8.211～13.089),전통개복조환자위9.7개월(95％ CI:5.804～ 10.596),조간차이무통계학의의(x2=3.481,P=0.062).수술전2조환자적CEA、NSE、CYFRA21-1、CA125、CA19-9,hs-CRP화응혈공능응혈매원시간(PT)、활화부분응혈활매시간(APTT)、섬유단백원(FIB)、응혈매시간비교차이균무통계학의의(균P＞0.05),단수술후각항지표균유소개선,이차복강경조환자적강저폭도균명현고우전통개복조[CEA:(10.1±2.6) μg/L비(18.8±5.2) μg/L;NSE:(14±3) μg/L비(22±7)μg/L;CA125:(31±7)kU/L비(45±7) kU/L;CA19-9:(28±7)kU/L비(47±17)kU/L화hs-CRP:(2.3±0.7) mg/L비(2.9±0.9)mg/L] (P＜0.05).결론 복강경보조위암근치술대노년진전기위암유량호적림상효과,병차능명현개선혈청종류표지물화hs-CRP수평.
Objective To investigate the long-term clinical efficiency of laparoscopic-assisted radical gastrectomy in the treatment of advanced gastric cancer and the effects on the serum tumor markers and high sensitive C reactive protein (hs-CRP) in elderly patients.Methods Totally 86 elderly patients of advanced gastric cancer from August 2008 to June 2012 were enrolled and divided into laparoscopic group (43 cases) and laparotomy group (43 cases).The long-term therapeutic efficiency was evaluated.The levels of serum tumor markers including carcino embryonic antigen (CEA),neuron-specific enolase (NSE),cytokeratin fragment antigen 21-1 (CYFRA21-1) carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9(CA19-9),hs-CRP,blood coagulation index before and after operation were measured and compared between two groups.Results The operation time and the number of dissected lymph node showed no significant difference between two groups (P ＞ 0.05);bleeding,using times of analgesic,gastrointestinal recovery time,hospitalization time and incidence of adverse reactions in laparoscopic group were significantly lower than those in traditional laparotomy group [(89 ±19) mlvs (122±25) ml,(0.68 ±0.28) timesvs (2.19 ±0.53) times,(2.6 ±0.4) d vs (3.9 ±0.5) d,(9.1 ±1.8) d vs (12.6 ±2.4) d,14.0％ (6/43) vs 39.5％ (17/43),P＜0.05];overall survival of laparoscopic group and laparotomy group had no significant difference [10.2 months (95％ CI:8.211-13.089) and 9.7 months (95％ CI:5.804-10.596) (x2 =3.481,P =0.062).The serum tumor markers,coagulation indices and hs-CRP showed no significant differences between two groups before operation (P ＞ 0.05);they were all improved after operation.The levels of CEA,NSE,CA125,CA19-9 and hs-CRP in laparoscopic group were all significantly lower compared with those in laparotomy group after operation [(10.1 ± 2.6) μg/L vs (18.8 ±5.2) μ.g/L,(14±3) μg/L vs (22±7) μg/L,(31 ±7) kU/L vs (45 ±7) kU/L,(28 ±7) kU/L vs (47±17) kU/L,(2.3±0.7) mg/Lvs (2.9±0.9) mg/L,P＜0.05)].Conclusion Laparoscopic-assisted radical gastrectomy can significantly improve the levels of hs-CRP and serum tumor markers with good therapeutic effect in the elderly patients of advanced gastric cancer.
