中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
Chinese Journal of Experimental Surgery
2015年
10期
2560-2562
,共3页
目的 观察联合脾脏切除对晚期结肠癌姑息性肿瘤切除患者免疫功能及预后的影响.方法 63例晚期结肠癌患者,其中27例行姑息性左半结肠切除联合脾切除(切脾组),36例单纯行姑息性左半结肠切除术(保脾组).分别检测术前、术后10d、术后6个月及术后12个月两组免疫功能,比较两组患者术后感染性并发症、术后平均住院时间、中位生存时间及1年生存率情况.结果 切脾组与保脾组患者术前及术后10 d体液免疫功能(IgA、IgG、IgM)和细胞免疫功能(CD3、CD4、CD8、CD4/CD8)各项指标比较,差异均无统计学意义(t=0.79、0.57、0.09、0.58、0.04、0.46、0.82,P＞0.05;t=0.61、0.11、0.74、0.41、1.04、0.55、0.85,P＞0.05);术后6个月及12个月保脾组患者免疫功能优于切脾组,除术后12个月CD8外(t=0.79,P＞0.05),其余免疫功能指标差异有统计学意义(t=3.47、2.83、2.41、2.97、2.66、2.65、3.07,P＜0.05;t 4.86、4.60、3.40、3.08、2.45、2.12,P＜0.05).保脾组在术后感染性并发症发生率(25％)、中位生存时间[(20.5±6.9)月]、1年生存率(88.9％)与切脾组[33％,(18.67±5.7)月,85.2％]比较,差异无统计学意义(x2=0.53,t=1.13,x2 =0.19,P＞0.05).术后平均住院时间保脾组(11.22±2.60)d显著短于切脾组[(13.56±4.60)d,=2.57,P＜0.05].结论 对于不可根治的晚期结肠癌患者,姑息性手术切除原发灶在一定时间内改善患者的免疫抑制状况,延长生存期.扩大的脾脏切除术并不能提高患者的预后,相反保留脾脏者,手术恢复较快,术后6 ～12个月期间的免疫功能的改善更好.
目的 觀察聯閤脾髒切除對晚期結腸癌姑息性腫瘤切除患者免疫功能及預後的影響.方法 63例晚期結腸癌患者,其中27例行姑息性左半結腸切除聯閤脾切除(切脾組),36例單純行姑息性左半結腸切除術(保脾組).分彆檢測術前、術後10d、術後6箇月及術後12箇月兩組免疫功能,比較兩組患者術後感染性併髮癥、術後平均住院時間、中位生存時間及1年生存率情況.結果 切脾組與保脾組患者術前及術後10 d體液免疫功能(IgA、IgG、IgM)和細胞免疫功能(CD3、CD4、CD8、CD4/CD8)各項指標比較,差異均無統計學意義(t=0.79、0.57、0.09、0.58、0.04、0.46、0.82,P＞0.05;t=0.61、0.11、0.74、0.41、1.04、0.55、0.85,P＞0.05);術後6箇月及12箇月保脾組患者免疫功能優于切脾組,除術後12箇月CD8外(t=0.79,P＞0.05),其餘免疫功能指標差異有統計學意義(t=3.47、2.83、2.41、2.97、2.66、2.65、3.07,P＜0.05;t 4.86、4.60、3.40、3.08、2.45、2.12,P＜0.05).保脾組在術後感染性併髮癥髮生率(25％)、中位生存時間[(20.5±6.9)月]、1年生存率(88.9％)與切脾組[33％,(18.67±5.7)月,85.2％]比較,差異無統計學意義(x2=0.53,t=1.13,x2 =0.19,P＞0.05).術後平均住院時間保脾組(11.22±2.60)d顯著短于切脾組[(13.56±4.60)d,=2.57,P＜0.05].結論 對于不可根治的晚期結腸癌患者,姑息性手術切除原髮竈在一定時間內改善患者的免疫抑製狀況,延長生存期.擴大的脾髒切除術併不能提高患者的預後,相反保留脾髒者,手術恢複較快,術後6 ～12箇月期間的免疫功能的改善更好.
목적 관찰연합비장절제대만기결장암고식성종류절제환자면역공능급예후적영향.방법 63례만기결장암환자,기중27례행고식성좌반결장절제연합비절제(절비조),36례단순행고식성좌반결장절제술(보비조).분별검측술전、술후10d、술후6개월급술후12개월량조면역공능,비교량조환자술후감염성병발증、술후평균주원시간、중위생존시간급1년생존솔정황.결과 절비조여보비조환자술전급술후10 d체액면역공능(IgA、IgG、IgM)화세포면역공능(CD3、CD4、CD8、CD4/CD8)각항지표비교,차이균무통계학의의(t=0.79、0.57、0.09、0.58、0.04、0.46、0.82,P＞0.05;t=0.61、0.11、0.74、0.41、1.04、0.55、0.85,P＞0.05);술후6개월급12개월보비조환자면역공능우우절비조,제술후12개월CD8외(t=0.79,P＞0.05),기여면역공능지표차이유통계학의의(t=3.47、2.83、2.41、2.97、2.66、2.65、3.07,P＜0.05;t 4.86、4.60、3.40、3.08、2.45、2.12,P＜0.05).보비조재술후감염성병발증발생솔(25％)、중위생존시간[(20.5±6.9)월]、1년생존솔(88.9％)여절비조[33％,(18.67±5.7)월,85.2％]비교,차이무통계학의의(x2=0.53,t=1.13,x2 =0.19,P＞0.05).술후평균주원시간보비조(11.22±2.60)d현저단우절비조[(13.56±4.60)d,=2.57,P＜0.05].결론 대우불가근치적만기결장암환자,고식성수술절제원발조재일정시간내개선환자적면역억제상황,연장생존기.확대적비장절제술병불능제고환자적예후,상반보류비장자,수술회복교쾌,술후6 ～12개월기간적면역공능적개선경호.
Objective To observe the impacof splenectomy on the prognosiand immune function of advanced colon cancer patients undergoing palliative resection.MethodSixty-three caseof advanced colon carcinomwere divided into splenectomy group given palliative lefhemicolectomy plusplenectomy (n =27) and spleen preservation group given palliative lefhemicolectomy only (n =36).The immune function before operation and on the postoperative day 10, month 6 and 12.ResultBefore operation and on the postoperative day 10, there wano statistically significandifference between two groupin the humoral immunity (IgA, IgG, IgM) and cell mediated immunity (CD3, CD4, CD8, CD4/CD8) (=0.79,0.57, 0.09, 0.58, 0.04, 0.46, 0.82,P＞0.05;t=0.61, 0.11, 0.74, 0.41, 1.04, 0.55, 0.85, P ＞ 0.05), buon the posotopertive month 6 and 12, immune function of spleen preservation group wamuch strongethan splenectomy group, excepCD8 on the postoperative month 12 (=0.79, P＞ 0.05), and the serum levelof CD3, CD4, IgA, IgM, IgG and CD4/CD8 in spleen preservation group were significantly highethan splenectomy group (=3.47, 2.83, 2.41, 2.97, 2.66, 2.65, 3.07, P ＜ 0.05;=4.86, 4.60, 3.40, 3.08, 2.45, 2.12,P ＜0.05).There wano statistically significandifference between two groupin infectioucomplications, the average length of stay and the one-yeasurvival rate [fospleen preservation group: 25％, (20.5 ± 6.9) months, and 88.9％, and fosplenectomy group: 33％, (18.67 ±5.7) months, 85.2％ ,x2 =0.53,=1.13,x2 =0.19,P＞0.05] ,buthe average lengthof hopstial stay aftethe operation in spleen preservation group [(11.22 ± 2.60) days] were significantly shortethan those in splenectomy group [(13.56 ± 4.60) days, =2.57, P ＜ 0.05].Conclusion Fopatientwith advanced colon canceimpossiblly nogiven radical resection, imay be possible to significantly reversal the immune function of spleen and improve the patient' quality of life by palliative lefhemicolectomy thacould decrease the tumoburden.Athe same time expanding splenectomy did noimprove the prognosiof patients.On the contrary, preserved spleen may lead to quick recovery, and improvemenof immune function and prognosis.
