分析置入肠道支架联合新辅助化疗对梗阻型左半结肠癌患者手术效果及肿瘤恶性生物学行为的影响

doi:10.3969/j.issn.10073205.2019.01.015

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗分析置入支架联合新辅助化疗对梗阻型左半结肠癌患者手术效果及肿瘤恶性生物学行为的影响。
〖HTH〗方法〖HTSS〗〖KG*2〗回顾性分析81例左半结肠癌引起急性肠梗阻患者的临床资料。根据治疗方法不同分为对照组42例和试验组39例，对照组采用开腹结肠癌根治术，试验组采用置入支架解除梗阻后化疗，并延期行开腹结肠癌根治术。留取血清样本检测肿瘤标志物水平，取肿瘤组织检测恶性分子表达量。比较2组手术时间、术中失血情况、术中切除组织中淋巴结数目、手术至排气时间、肠管吻合口漏发生率、Ⅰ期切除吻合情况、切口感染率。
〖HTH〗结果〖HTSS〗〖KG*2〗对照组术后血清癌胚抗原（carcinoembryonic antigen，CEA）、CA724、CA199、CA125水平均明显低于入院时（P＜0.05）；试验组化疗后和术后血清 CEA、CA724、CA199、CA125水平均明显低于入院时，术后血清 CEA、CA724、CA199、CA125水平均明显低于化疗后（P＜0.05）；术后试验组血清 CEA、CA724、CA199、CA125水平均明显低于对照组(P＜005)。试验组肿瘤组织中SMYD3、CHD1L、骨桥蛋白和Survivin的mRNA表达量均明显低于对照组(P＜005)。试验组手术时间、手术至排气时间均短于对照组，术中失血量少于对照组，肠管吻合口漏发生率、切口感染率均明显低于对照组，Ⅰ期切除吻合率明显高于对照组(P＜005)。
〖HTH〗结论〖HTSS〗〖KG*2〗梗阻型左半结肠癌置入支架解除梗阻后接着行新辅助下化疗，然后实施结肠癌根治术治疗，可有效减低肿瘤组织的生物学恶性程度，抑制肿瘤组织恶性分子表达等恶性生物学行为，降低肿瘤分级分期，有效规避急诊手术，从而降低手术风险，增加手术效果，患者最终获益。

关键词: 结肠肿瘤, 肠梗阻, 肠道支架, 放化疗, 辅助

Abstract: 〗［Abstract］〓Objective〖HTSS〗〓To analyze the effect of stent implantation combined with neoadjuvant chemotherapy on the surgical outcome and malignant biological behavior of the patients with obstructive leftsided obstructing colon cancer.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The clinical data of 81 patients with acute intestinal obstruction caused by left colon cancer were retrospectively analyzed. According to the different treatment methods，there were 42 cases in the control group and 39 patients in the experimental group. The control group underwent radical open colon resection for colon cancer. The experimental group were received the chemotherapy after the stent was implanted, and the delayed radical colon surgery .The serum samples were taken to detect the level of tumor markers, and tumor tissues were taken to detect the expression of malignant molecules. The blood loss during operation, the number of lymph nodes, the time from operation to exhaust, the incidence of intestinal anastomosis leakage the condition of stage one resection and complete anastomosis, and the infection rate of incision were compared between the two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The levels of serum carcinoembryonic antigen(CEA), CA724, CA199 and CA125 in the control group were significantly lower than those before the operation(P＜005). The levels of serum CEA, CA724, CA199 and CA125 in the experimental group were significantly lower than those before the operation, the levels of serum CEA, CA724, CA199 and CA125 were significantly lower than those after chemotherapy(P＜005). The levels of serum CEA, CA724, CA199 and CA125 in the experimental group were significantly lower than those in the control group(P＜005). After surgical resection, the mRNA expression levels of the SMYD3, CHD1L， osteopontin and Survivin in the experimental group was significantly lower than those in the control group(P＜005). In the experimental group, the time of operation, the amount of blood lost during operation, the incidence of anastomotic leakage, and the incidence of incision infection were significantly lower than those in the control group， the rate of one stage anastomosis after resection was significantly higher than that of control group(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Obstructive left colon cancer with stent implanted to relieve the obstruction and followed by neoadjuvant chemotherapy and then radical mastectomy can effectively reduce the biological malignancy of tumor tissue and inhibit the malignant molecular expression of malignant biological behavior, reduce tumor grading and staging, and effectively avoid emergency surgery, thus reduce the risk of surgery, increase the surgical effect, and eventually benefiting.

Key words: colonic neoplasms, intestinal obstruction, intestinal stent, chemoradiotherapy, adjuvant

李旭斌，贾军峰*，张其军，单海丰，张〓杰. 分析置入肠道支架联合新辅助化疗对梗阻型左半结肠癌患者手术效果及肿瘤恶性生物学行为的影响[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2019.01.015.

LI Xubin, JIA Junfeng*, ZHANG Qijun, SHAN Haifeng, ZHANG Jie. Effects of intestinal stents implantation combined with neoadjuvant chemotherapy on surgical operation and malignant biological behavior of patients with obstructive left hemicolon carcinoma#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2019.01.015.

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分析置入肠道支架联合新辅助化疗对梗阻型左半结肠癌患者手术效果及肿瘤恶性生物学行为的影响

Effects of intestinal stents implantation combined with neoadjuvant chemotherapy on surgical operation and malignant biological behavior of patients with obstructive left hemicolon carcinoma#br#

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