腹腔镜远端胃癌根治术对进展期胃癌患者肿瘤微转移及血清学指标的影响探究
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摘要
目的探究腹腔镜远端胃癌根治术对进展期胃癌患者肿瘤微转移及血清学指标的影响,分析其临床应用价值。方法采用前瞻性对照分析方法,选取本院2016年4月至2018年5月收治的92例远端进展期胃癌患者为研究对象,采用随机数表法将其分为腹腔镜组和开腹组,每组各46例,分别接受腹腔镜远端胃癌根治术和开腹远端胃癌根治术治疗,检测两组患者手术开始时和手术结束前腹腔冲洗液中多巴脱羧酶(dopa decarboxylase,DDC)、癌胚抗原(carcinoe mbryonic antigen,CEA)水平变化,分析胃癌微转移状态;并检测患者术前和术后12周血清肿瘤标志物、血管内皮生长因子(vascular endothelial growth factor,VEGF)、基质金属蛋白酶(matrix metalloproteinase,MMP)水平变化,总结两种术式对患者肿瘤复发转移相关指标的影响。结果腹腔镜组患者术中出血量显著少于开腹组(P <0.05),肛门排气时间和住院天数均显著短于开腹组(P_均<0.05)。手术结束前,两组患者腹腔冲洗液中DDC、CEA水平均显著高于本组手术开始时(P_均<0.05);腹腔镜组患者手术结束前腹腔冲洗液中DDC、CEA水平均显著低于开腹组(P_均<0.05)。术后12周,两组患者血清CEA、糖类蛋白(carbohydrate antigen,CA)724、CA50、MMP-2、MMP-9、MMP-11、VEGF-A、VEGF-C、VEGF-D水平均显著低于本组术前(P_均<0.05);腹腔镜组患者术后12周血清MMP-2、MMP-9、MMP-11及VEGF-D水平均显著低于开腹组(P_均<0.05)。结论较开腹术式而言,腹腔镜远端胃癌根治术对患者肿瘤复发转移相关指标具有更为积极的影响,且能降低术后肿瘤微转移风险。
Objective To explore the effect of laparoscopic radical distal gastrectomy on tumor micrometastasis and serological parameters in patients with advanced gastric cancer, and to analyze its clinical value. Method 92 patients with distal advanced gastric cancer admitted to our hospital from April 2016 to May 2018 were randomly divided into laparoscopic group and laparotomy group, 46 cases in each group. Two groups of patients underwent laparoscopic and open radical gastrectomy for distal gastric cancer.The changes of dopa decarboxylase(DDC) and carcinoembryonic antigen(CEA) in peritoneal lavage ?uid at the beginning and before the end of operation were detected. The micrometastasis status of gastric cancer was analyzed. Serum tumor markers and vascular endothelial growth factor(VEGF) were detected before and 12 weeks after operation. The changes of matrix metalloproteinase(MMP)and the effects of two surgical methods on the related indicators of recurrence and metastasis of tumors were summarized. Result The amount of bleeding in laparoscopic group was signi?cantly less than that in laparotomy group(P < 0.05), and the time of anal exhaust and hospitalization were signi?cantly shorter than that in laparotomy group(P_(all)< 0.05). Before the end of operation, the levels of DDC and CEA in peritoneal lavage ?uid of the two groups were signi?cantly higher than those at the beginning of operation(P_(all)< 0.05). The levels of DDC and CEA of peritoneal lavage ?uid before the end of operation in laparoscopic group were lower than those in laparotomy group(P_(all)< 0.05). The levels of serum CEA, carbohydrate antigen(CA) 724, CA50, MMP-2, MMP-9,VEGF-A, VEGF-C, and VEGF-D in the two groups decreased 12 weeks after operation(P_(all)< 0.05), while the levels of serum MMP-11, MMP-2, MMP-9, MMP-11 and VEGF-D in laparoscopic group were lower than those in laparotomy group 12 weeks after operation(P_(all)< 0.05). Conclusion Compared with open radical gastrectomy, laparoscopic radical gastrectomy for distal gastric cancer has a more positive impact on tumor recurrence and metastasis related indicators, and can reduce the risk of tumor micrometastasis after operation.
Objective To explore the effect of laparoscopic radical distal gastrectomy on tumor micrometastasis and serological parameters in patients with advanced gastric cancer, and to analyze its clinical value. Method 92 patients with distal advanced gastric cancer admitted to our hospital from April 2016 to May 2018 were randomly divided into laparoscopic group and laparotomy group, 46 cases in each group. Two groups of patients underwent laparoscopic and open radical gastrectomy for distal gastric cancer.The changes of dopa decarboxylase(DDC) and carcinoembryonic antigen(CEA) in peritoneal lavage ?uid at the beginning and before the end of operation were detected. The micrometastasis status of gastric cancer was analyzed. Serum tumor markers and vascular endothelial growth factor(VEGF) were detected before and 12 weeks after operation. The changes of matrix metalloproteinase(MMP)and the effects of two surgical methods on the related indicators of recurrence and metastasis of tumors were summarized. Result The amount of bleeding in laparoscopic group was signi?cantly less than that in laparotomy group(P < 0.05), and the time of anal exhaust and hospitalization were signi?cantly shorter than that in laparotomy group(P_(all)< 0.05). Before the end of operation, the levels of DDC and CEA in peritoneal lavage ?uid of the two groups were signi?cantly higher than those at the beginning of operation(P_(all)< 0.05). The levels of DDC and CEA of peritoneal lavage ?uid before the end of operation in laparoscopic group were lower than those in laparotomy group(P_(all)< 0.05). The levels of serum CEA, carbohydrate antigen(CA) 724, CA50, MMP-2, MMP-9,VEGF-A, VEGF-C, and VEGF-D in the two groups decreased 12 weeks after operation(P_(all)< 0.05), while the levels of serum MMP-11, MMP-2, MMP-9, MMP-11 and VEGF-D in laparoscopic group were lower than those in laparotomy group 12 weeks after operation(P_(all)< 0.05). Conclusion Compared with open radical gastrectomy, laparoscopic radical gastrectomy for distal gastric cancer has a more positive impact on tumor recurrence and metastasis related indicators, and can reduce the risk of tumor micrometastasis after operation.
引文
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[2]杜大军.腹腔镜辅助D2根治术对远端进展期胃癌患者肿瘤及复发转移相关指标的影响研究[J].实用癌症杂志,2017,32(5):713-715.
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[5]张英杰,梁金荣.腹腔镜胃癌根治术治疗进展期胃癌患者的近期疗效及对腹腔内微转移的影响[J].中华全科医学,2017,15(11):1867-1869.
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[8]Chen QY,Zheng CH,Li P,et al.Safety and prognostic impact of prophylactic laparoscopic superior mesenteric vein(No.14v)lymph node dissection for lower-third gastric cancer:a propensity score-matched case-control study[J].Surg Endosc,2018,32(3):1495-1505.
[9]张帆,郝迎学,唐波,等.不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响[J].中华消化外科杂志,2015,14(5):400-404.
[10]Hara T,Etoh T,Ueda Y,et al.A case of undifferentiated-type mucosal gastric cancer with multiple lymph node metastases fulfilling the curative criteria for endoscopic resection according to routine pathological analysis[J].Surg Case Rep,2016,2(1):96.
[11]黄文伟,童仕伦,郑勇斌.腹腔镜胃癌根治术对机体免疫功能、应激反应及微转移的影响[J].现代消化及介入诊疗,2015,20(6):682-685.
[12]Sasako M.Is there role for laparoscopic gastrectomy for advanced gastric cancer[J].Eur J Surg Oncol,2017,43(6):965-967.
[13]Aizawa M,Honda M,Hiki N,et al.Oncological outcomes of function-preserving gastrectomy for early gastric cancer:a multicenter propensity score matched cohort analysis comparing pylorus-preserving gastrectomy versus conventional distal gastrectomy[J].Gastric Cancer,2017,20(4):709-717.
[14]Fujimura T,Fushida S,Tsukada T,et al.A new stage of sentinel node navigation surgery in early gastric cancer[J].Gastric Cancer,2015,18(2):210-217.
[15]石鑫,刘宏斌,李洪涛,等.腹腔镜“淋巴引流区”清扫联合胃局部切除术治疗早期胃癌的再认识[J].肿瘤防治研究,2018,45(2):101-105.
[16]Jongerius EJ,Boerma D,Seldenrijk KA,et al.Role of omentectomy as part of radical surgery for gastric cancer[J].Br J Surg,2016,103(11):1497-1503.
[17]Yamada T,Tsuburaya A,Hayashi T,et al.Usefulness of Surgical Apgar Score on predicting survival after surgery for gastric cancer[J].Ann Surg Oncol,2016,23(5):757-763.
[18]Abe S,Oda I,Nakajima T,et al.A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer[J].Gastric Cancer,2015,18(1):188-192.
[2]杜大军.腹腔镜辅助D2根治术对远端进展期胃癌患者肿瘤及复发转移相关指标的影响研究[J].实用癌症杂志,2017,32(5):713-715.
[3]Yashiro M,Matsuoka T.Sentinel node navigation surgery for gastric cancer:Overview and perspective[J].World JGastrointest Surg,2015,7(1):1-9.
[4]Park JY,Kim YW,Ryu KW,et al.Assessment of laparoscopic stomach preserving surgery with sentinel basin dissection versus standard gastrectomy with lymphadenectomy in early gastric cancer-A multicenter randomized phaseⅢclinical trial(SENORITA trial)protocol[J].BMC Cancer,2016,16:340.
[5]张英杰,梁金荣.腹腔镜胃癌根治术治疗进展期胃癌患者的近期疗效及对腹腔内微转移的影响[J].中华全科医学,2017,15(11):1867-1869.
[6]Marano L,Polom K,Patriti A,et al.Surgical management of adva nced gastric cancer:An evolving issue[J].Eur J Surg Oncol,2016,42(1):18-27.
[7]Tani T,Sonoda H,Tani M.Sentinel lymph node navigation surgery for gastric cancer:Does it really benefit the patient?[J].World J Gastroenterol,2016,22(10):2894-2899.
[8]Chen QY,Zheng CH,Li P,et al.Safety and prognostic impact of prophylactic laparoscopic superior mesenteric vein(No.14v)lymph node dissection for lower-third gastric cancer:a propensity score-matched case-control study[J].Surg Endosc,2018,32(3):1495-1505.
[9]张帆,郝迎学,唐波,等.不同浆膜受侵犯面积胃癌患者行腹腔镜胃癌根治术对腹腔微转移的影响[J].中华消化外科杂志,2015,14(5):400-404.
[10]Hara T,Etoh T,Ueda Y,et al.A case of undifferentiated-type mucosal gastric cancer with multiple lymph node metastases fulfilling the curative criteria for endoscopic resection according to routine pathological analysis[J].Surg Case Rep,2016,2(1):96.
[11]黄文伟,童仕伦,郑勇斌.腹腔镜胃癌根治术对机体免疫功能、应激反应及微转移的影响[J].现代消化及介入诊疗,2015,20(6):682-685.
[12]Sasako M.Is there role for laparoscopic gastrectomy for advanced gastric cancer[J].Eur J Surg Oncol,2017,43(6):965-967.
[13]Aizawa M,Honda M,Hiki N,et al.Oncological outcomes of function-preserving gastrectomy for early gastric cancer:a multicenter propensity score matched cohort analysis comparing pylorus-preserving gastrectomy versus conventional distal gastrectomy[J].Gastric Cancer,2017,20(4):709-717.
[14]Fujimura T,Fushida S,Tsukada T,et al.A new stage of sentinel node navigation surgery in early gastric cancer[J].Gastric Cancer,2015,18(2):210-217.
[15]石鑫,刘宏斌,李洪涛,等.腹腔镜“淋巴引流区”清扫联合胃局部切除术治疗早期胃癌的再认识[J].肿瘤防治研究,2018,45(2):101-105.
[16]Jongerius EJ,Boerma D,Seldenrijk KA,et al.Role of omentectomy as part of radical surgery for gastric cancer[J].Br J Surg,2016,103(11):1497-1503.
[17]Yamada T,Tsuburaya A,Hayashi T,et al.Usefulness of Surgical Apgar Score on predicting survival after surgery for gastric cancer[J].Ann Surg Oncol,2016,23(5):757-763.
[18]Abe S,Oda I,Nakajima T,et al.A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer[J].Gastric Cancer,2015,18(1):188-192.
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