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学科主题肿瘤学
腹腔镜辅助与开腹胃癌根治术治疗胃癌患者免疫功能比较及其临床意义
宫超凡
2016-05-25
导师苏向前
专业肿瘤学
授予单位北京大学
授予地点北京大学临床肿瘤学院
学位硕士
关键词胃癌 腹腔镜 胃切除 免疫反应 细胞因子
其他题名Evaluation of immune responses of gastric cancer patients treated by laparoscopic and open gastrectomy
分类号R735.2
摘要

目的:腹腔镜辅助胃癌根治术(Laparoscopy-assisted gastrectomy,LAG)在早期胃癌治疗中的确切疗效已被业界广泛接受,然而,LAG在进展期胃癌中的应用仍存争议,同时病人术后免疫学功能情况尚不十分清楚。本研究通过比较接受腹腔镜辅助与传统开腹(OG)手术治疗的胃癌患者免疫功能状态,分析两种术式治疗胃癌对患者免疫学功能的影响。

方法:本研究前瞻性研究了2011年1月至4月间就诊于北京大学肿瘤医院胃肠肿瘤中心四病区的70例行D2胃癌根治术患者的免疫学功能。将70例患者随机入组分为LAG和OG组,根据详细的手术记录和术后病程记录对患者术中和术后临床病例资料进行比较。术前以及术后第1、3、7天对患者相关免疫学指标进行测定,比较两组患者免疫学功能。

结果:LAG和OG组患者临床病例特征无显著差异。两组患者白细胞、中性粒细胞、淋巴细胞,以及不同淋巴细胞亚型,包括T淋巴细胞、B淋巴细胞、CD4+T细胞、CD8+T细胞均无显著差异。仅术后第7天,天然杀伤细胞(Nature Killer)数目在LAG组患者明显高于OG组患者。此外,两组患者围手术期细胞因子水平,包括IFN-γ、IL-4、IL-6和TNFα水平均无明显差异。然而,与OG组相比,LAG组大多数细胞因子在术后第7天趋向于恢复至术前水平。

结论:本研究结果提示,LAG组患者与OG组患者免疫学功能相似。然而,尚需要较大规模的前瞻性多中心临床试验对LAG患者的免疫学状态进行评估,以验证本研究结论的正确性。

英文摘要

Object: Laparoscopic surgery has been shown to offer more advantages than open surgery for the treatment of gastric cancer. However, the perioperative immune responses after laparoscopic surgery remain largely unexplored. Here, we analyzed the immunity of gastric cancer patients treated by laparoscopy-assisted gastrectomy (LAG) or open gastrectomy (OG) with D2 dissection.

Methods: Between January and April 2011, 70 patients with gastric cancer were enrolled in this prospective study and underwent gastrectomy with D2 lymph node dissection at the Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute. The operative details and postoperative outcomes of the two groups were compared. The immune factors were measured preoperatively as well as on the first, third and seventh postoperative days (POD).

Results: There was no significant difference between two groups in clinical acteristics. The profiles of white blood cells, neutrophils, lymphocytes, as well as the lymphocyte subpopulations, including T lymphocytes, B lymphocytes, CD4+T cells and CD8+T cells were similar in the LAG and the OG groups. Only the natural killer (NK) cell counts were significantly higher in LAG treated patients than in OG treated ones on POD7. Moreover, no statistical differences were found between the two groups with respect to the levels of perioperative cytokines, including IFN-γ, IL-4, IL-6 and TNF-α. However, compared with the OG group, most of the immune factors in the LAG group had trends to return to preoperative levels on POD7.

Conclusions: Our study demonstrates that the immune function of LAG treated patients showed patterns similar to that of OG treated patients, although larger prospective multicenter trials are needed to further evaluate the immunological status of LAG.

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/125694
专题北京大学临床肿瘤学院
作者单位北京大学临床肿瘤学院
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GB/T 7714
宫超凡. 腹腔镜辅助与开腹胃癌根治术治疗胃癌患者免疫功能比较及其临床意义[D]. 北京大学临床肿瘤学院. 北京大学,2016.
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