新辅助化疗联合腹腔镜治疗进展期胃癌效果及MMP、PG、VEGF水平观察

杨兴业; 赵小军

doi:10.3969/j.issn.1671-038X.2019.01.14

新辅助化疗联合腹腔镜治疗进展期胃癌效果及MMP、PG、VEGF水平观察

杨兴业^,,
赵小军

- 泰州市人民医院普外科, 江苏泰州 225300
基金项目:
江苏省泰州市社会发展科技项目编号（No：TS2013006）

详细信息

作者简介:
杨兴业,男,副主任医师,研究方向:腹腔镜外科

通讯作者: 杨兴业,E-mail:yangxingye0523@163.com

中图分类号: R735.2

收稿日期: 2018-08-01

Effect of neoadjuvant chemotherapy combined with laparoscopy in the treatment of advanced gastric cancer and the expression levels of MMP, PG and VEGF

YANG Xing-ye^,,
ZHAO Xiao-jun

- Department of General Surgery, People's Hospital of Taizhou City, Taizhou 225300, China

More Information

Corresponding author: YANG Xing-ye, E-mail: yangxingye0523@163.com

Received Date: 01 August 2018

摘要

摘要: [目的]探究新辅助化疗联合腹腔镜治疗进展期胃癌的临床效果及对患者预后的影响。[方法]选取2013年12月~2015年1月本院收治的102例进展期胃癌患者作为研究对象，利用随机数字表法分为对照组与观察组，每组各51例。对照组患者采取腹腔镜下胃癌根治术，观察组患者在行腹腔镜下胃癌根治术前先进行新辅助化疗。治疗2个疗程后，比较2组术后疗效及不良反应发生情况；比较2组围术期指标、生活质量情况及手术前后金属蛋白酶、胃蛋白酶原、血管内皮生长因子水平变化；比较2组术后3年生存率。[结果]观察组与对照组根治性切除率分别为为86.3%和70.6%，2组切除率比较差异显著（P<0.05）。2组术后并发症、血液学毒性反应及消化系统毒性反应发生率差异均无统计学意义（P>0.05）。2组手术时间、出血量、淋巴结清扫数目、下床活动时间、肛门排气时间及住院时间等围术期指标均无显著差异（P>0.05）。观察组生活质量恢复总有效率分别为92.2%和80.4%，观察组生活质量恢复情况显著优于对照组（P<0.05）。2组治疗后较治疗前MMP-2、MMP-9、PGⅡ、VEGF-A水平均显著降低（P<0.05），且治疗后观察组较对照组MMP-2、MMP-9、PGⅡ、VEGF-A水平更低（P<0.05）。2组治疗后PGⅠ、VEGF-D水平均显著升高（P<0.05），且治疗后观察组较对照组PGⅠ、VEGF-D水平更高（P<0.05）。对照组3年内生存率均显著低于观察组（P<0.05）。[结论]新辅助化疗联合腹腔镜治疗进展期胃癌疗效显著、安全性较高，有助于患者生活质量的改善，提高患者生存率，且能够调节MMP、PG、VEGF的分泌水平，在进展期胃癌的临床治疗中具有重要意义。
- 胃癌 /
- 新辅助化疗 /
- 腹腔镜治疗 /
- MMP /
- PG /
- VEGF
Abstract: [Objective] To explore the clinical effect of neoadjuvant chemotherapy combined with laparoscopy in the treatment of advanced gastric cancer. [Methods] 102 patients with advanced gastric cancer admitted to our hospital from December 2013 to January 2015 were enrolled in our study. The patients were randomly divided into the control group and the observation group by random number table method, 51 cases in each group. The patients in the control group were treated with laparoscopic radical gastrectomy, and the patients in the observation group were treated with new adjuvant chemotherapy before laparoscopic radical gastrectomy. The effect of two groups after operation and the occurrence of adverse reaction were compared, the indexes of perioperative period, quality of life in two groups and the changes of MMP, PG and VEGF before and after operation were compared. [Results] The radical resection rate of the observation group and the control group was 86.3% and 70.6% respectively. There was significantly difference in the radical resection rate between the observation and control groups (P<0.05). There were no significant difference in the incidence of postoperative complications, hematological toxicity and digestive system toxicity between the two groups (P>0.05). There were no significant difference in operative time, bleeding volume, lymph node dissection, ambulation time, anal exhaust time and hospitalization time between the two groups (P>0.05). The total effective rate of quality of life recovery in the observation group was 92.2% and 80.4% respectively. The recovery of quality of life in the observation group was significantly better than that of the control group (P<0.05). After treatment, the levels of MMP-2, MMP-9, PG II and VEGF-A in the two groups were significantly lower than those before treatment (P<0.05), and the levels of MMP-2, MMP-9, PG II and VEGF-A in the observation group were lower than those in the control group (P<0.05). After treatment, the PG I and VEGF-D levels in both groups were increased significantly (P<0.05). The level of PG I and VEGF-D in the observation group was higher than that of the control group after treatment (P<0.05). The survival rate of the control group in three years was significantly lower than that in the observation group (P<0.05).[Conclusion] Neoadjuvant chemotherapy combined with laparoscopic treatment of advanced gastric cancer is effective and safe, which is helpful to improve the quality of life of patients, improve the survival rate of patients, and regulate the secretion of MMP, PG and VEGF. The clinical treatment is of great significance.
- gastric cancer /
- neoadjuvant chemotherapy /
- laparoscopic treatment /
- MMP /
- PG /
- VEGF

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参考文献(20)

[1]	左婷婷, 郑荣寿, 曾红梅, 等.中国胃癌流行病学现状[J].中国肿瘤临床, 2017, 44(1):52-58.
[2]	李国新.中国腹腔镜胃癌外科临床研究现状[J].中华消化外科杂志, 2016, 15(1):27-30.
[3]	Bǎlescu I, Godoroja D, Gongu M, et al.Laparoscopic HIPEC for Peritoneal Carcinomatosis from Gastric Cancer-Technique and Early Outcomes of Our First Cases[J].Chirurgia(Bucur), 2017, 112(6):714-725.
[4]	Houghton J, Stoicov C, Nomura S, et al.Gastric cancer originating from bone marrow-derived cells[J].Science, 2004, 306(5701):1568-1571.
[5]	Fan B, Xiong B.Investigation of serum tumor markers in the diagnosis of gastric cancer[J].Hepato-gastroenterology, 2016, 58(105):239-239.
[6]	熊兵红, 马利, 罗华友, 等.进展期胃癌新辅助化疗疗效评价:16个随机试验的荟萃分析[J].中国肿瘤, 2016, 25(7):559-568.
[7]	杨娟, 燕速.影响进展期胃癌新辅助化疗患者临床疗效的危险因素[J].实用癌症杂志, 2017, 32(5):770-772.
[8]	Hao Y, Yu P, Feng Q, et al.Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer:A retrospective study in a single minimally invasive surgery center[J].Medicine, 2016, 95(25):e3936.
[9]	Lin J X, Huang C M, Zheng C H, et al.Is All Advanced Gastric Cancer Suitable for Laparoscopy-Assisted Gastrectomy With Extended Lymphadenectomy? A Case-Control Study Using a Propensity Score Method[J].Ann Surg Oncol, 2016, 23(4):1252-1252.
[10]	吴梅青, 周旭坤, 李平, 等.新辅助化疗联合腹腔镜辅助D2近端胃癌根治术治疗近端进展期胃癌[J].中国微创外科杂志, 2014, 14(2):109-111.
[11]	宋杰, 陈凤格, 赵伟, 等.胃癌的发病率现状与治疗研究进展[J].中国慢性病预防与控制, 2016, 24(9):704-707.
[12]	Lee CM, Park DW, Park S, et al.Lymph Node Dissection Using Bipolar Vessel-Sealing Device During Reduced Port Laparoscopic Distal Gastrectomy for Gastric Cancer:Results of a Pilot Study from a Single Institute[J].J Laparoendosc Adv Surg Tech A, 2017, 27(11):1101-1108.
[13]	武梦娇, 王峰, 宋丽杰, 等.紫杉醇脂质体或常规紫杉醇联合S-1治疗进展期胃癌:药代动力学、疗效及安全性的比较[J].肿瘤, 2016, 36(3):303-309.
[14]	Chen X Z, Wang S Y, Wang Y S, et al.Comparisons of short-term and survival outcomes of laparoscopy-assisted versus open total gastrectomy for gastric cancer patients[J].Oncotarget, 2017, 8(32):52366-52380.
[15]	Yoshikawa T, Tanabe K, Nishikawa K, et al.Induction of a pathological complete response by four courses of neoadjuvant chemotherapy for gastric cancer:early results of the randomized phase II COMPASS trial[J].Ann Surg Oncol, 2014, 21(1):213-213.
[16]	王曼, 朱振红, 朱正秋.MACC1调节肝星状细胞表达MMP-2、MMP-9对胃癌细胞迁移侵袭能力的影响[J].胃肠病学和肝病学杂志, 2016, 25(7):765-768.
[17]	杨云鹏, 刘莉, 李慧.MMP-2、MMP-3和MMP-9在胃癌患者中的表达及意义[J].局解手术学杂志, 2016, 25(9):625-628.
[18]	Sjomina O, Pavlova J, Daugule I, et al.Pepsinogen test for the evaluation of precancerous changes in gastric mucosa:a population-based study[J].J Gastrointestin Liver Dis, 2018, 27(1):11-17.
[19]	Min A, Kim J E, Kim Y J, et al.Cyclin E overexpression confers resistance to the CDK4/6 specific inhibitor palbociclib in gastric cancer cells[J].Cancer Lett, 2018, 430:123-132.
[20]	Dai Y, Jiang J, Wang Y, et al.The correlation and clinical implication of VEGF-C expression in microvascular density and lymph node metastasis of gastric carcinoma[J].Am J Transl Res, 2016, 8(12):5741-5747.