腹腔镜微创手术对直肠癌患者凝血、抗氧化功能、血管新生、IGF-1及IFN-γ水平的影响
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摘要
目的:探究腹腔镜微创手术对直肠癌患者凝血、抗氧化功能、血管新生、类胰岛素1号增长因子(IGF-1)及干扰素-γ(IFN-γ)水平的影响。方法:选择2016年3月~2017年12月我院普外科收治的直肠癌患者90例,随机分为对照组(n=45)和观察组(n=45),对照组实施传统开腹手术治疗,观察组实施腹腔镜直肠癌根治术。比较两组患者凝血功能、抗氧化能力、血管新生、IGF-1及IFN-γ水平变化。结果:治疗前,两组凝血功能、抗氧化能力、血管新生、IGF-1及IFN-γ水平相比,无统计学意义(P>0.05)。治疗后,两组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)与治疗前相比,无统计学意义(P>0.05),而纤维蛋白原(FIB)及D二聚体(DD)均较治疗前显著增加(P<0.05),且观察组FIB及DD较对照组增加明显(P<0.05);两组超氧化物歧化酶(SOD)及谷胱甘肽(GSH)均较治疗前显著降低(P<0.05),而丙二醛(MDA)较治疗前显著增加(P<0.05),且观察组SOD、GSH降低幅度及MDA上升幅度显著大于对照组(P<0.05);两组血管内皮生长因子(VEGF)及基质金属蛋白酶-9(MMP-9)均较治疗前显著降低(P<0.05),且观察组VEGF及MMP-9较对照组降低明显(P<0.05);两组IGF-1均较治疗前显著降低(P<0.05),且观察组IGF-1较对照组降低明显(P<0.05);两组IFN-γ均较治疗前显著增加(P<0.05),且观察组IFN-γ较对照组增加明显(P<0.05)。结论:腹腔镜手术较开腹手术治疗直肠癌患者,较易导致患者血液呈高凝状态,但可有效避免机体肿瘤转移、产生的应激损伤更小,进而更好地促进患者的康复,值得临床推广。
Objective:To investigate the effects of laparoscopic minimally invasive surgery on coagulation,antioxidant function,angiogenesis,IGF-1 and IFN-γlevels in rectal cancer patients.Methods:A total of 90 patients with rectal cancer admitted to Department of General Surgery in our hospital from March 2016 to December 2017 were randomly divided into control group(n=45)and observation group(n=45).The control group underwent conventional open surgery,while the observation group underwent laparoscopic radical resection.The blood coagulation function,antioxidant capacity,angiogenesis,IGF-1 and IFN-γlevels were compared between the two groups.Results:Before treatment,there was no significant difference in coagulation function,antioxidant capacity,angiogenesis,IGF-1 and IFN-γlevels between the two groups(P>0.05).After treatment,there was no significant difference in PT and APTT between the two groups(P>0.05),while FIB and DD were significantly increased compared with before treatment(P<0.05),and the FIB and DD of the observation group increased significantly compared with the control group(P<0.05);the SOD and GSH of the two groups were significantly lower than those before treatment(P<0.05),while the MDA was significantly increased compared with that before treatment(P<0.05),the decrease of SOD,GSH and the increase of MDA in the observation group was significantly greater than that of the control group(P<0.05);the levels of VEGF,MMP-9 and IGF-1 in the two groups were significantly lower than those before treatment(P<0.05),and the VEGF,MMP-9 and IGF-1 in the observation group were significantly lower than those in the control group(P<0.05);the IFN-γlevels in the two groups were significantly higher than those before treatment(P<0.05),and the IFN-γwas significantly increased in the observation group compared with the control group(P<0.05).Conclusions:Compared with conventional open surgery,laparoscopic surgery for patients with rectal cancer can easily cause hypercoagulable state of the patient's blood,but it can effectively avoid tumor metastasis and less stress damage,and further promote the rehabilitation of the patients,which is worthy of clinical promotion.
Objective:To investigate the effects of laparoscopic minimally invasive surgery on coagulation,antioxidant function,angiogenesis,IGF-1 and IFN-γlevels in rectal cancer patients.Methods:A total of 90 patients with rectal cancer admitted to Department of General Surgery in our hospital from March 2016 to December 2017 were randomly divided into control group(n=45)and observation group(n=45).The control group underwent conventional open surgery,while the observation group underwent laparoscopic radical resection.The blood coagulation function,antioxidant capacity,angiogenesis,IGF-1 and IFN-γlevels were compared between the two groups.Results:Before treatment,there was no significant difference in coagulation function,antioxidant capacity,angiogenesis,IGF-1 and IFN-γlevels between the two groups(P>0.05).After treatment,there was no significant difference in PT and APTT between the two groups(P>0.05),while FIB and DD were significantly increased compared with before treatment(P<0.05),and the FIB and DD of the observation group increased significantly compared with the control group(P<0.05);the SOD and GSH of the two groups were significantly lower than those before treatment(P<0.05),while the MDA was significantly increased compared with that before treatment(P<0.05),the decrease of SOD,GSH and the increase of MDA in the observation group was significantly greater than that of the control group(P<0.05);the levels of VEGF,MMP-9 and IGF-1 in the two groups were significantly lower than those before treatment(P<0.05),and the VEGF,MMP-9 and IGF-1 in the observation group were significantly lower than those in the control group(P<0.05);the IFN-γlevels in the two groups were significantly higher than those before treatment(P<0.05),and the IFN-γwas significantly increased in the observation group compared with the control group(P<0.05).Conclusions:Compared with conventional open surgery,laparoscopic surgery for patients with rectal cancer can easily cause hypercoagulable state of the patient's blood,but it can effectively avoid tumor metastasis and less stress damage,and further promote the rehabilitation of the patients,which is worthy of clinical promotion.
引文
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14 于佳弘,于雪娇,杜晓雪,等.D-D、FIB、PLT等凝血功能指标与肺癌患者外周血CTC及病理特征的相关性研究[J].肿瘤药学,2017,7(5):596-599.
15 Kramer PA,Chacko BK,Ravi S,et al.Hemoglobinassociated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients[J].Lab Invest,2015,95(2):132-141.
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18 Chen L,Li S,Guo X,et al.The role of GSH in microcystin‐induced apoptosis in rat liver:Involvement of oxidative stress and NF-κB[J].Environ Toxicol,2016,31(5):552-560.
19 Kim A,Im M,Yim N H,et al.Reduction of metastatic and angiogenic potency of malignant cancer by Eupatorium fortunei via suppression of MMP-9activity and VEGF production[J].Sci Rep-UK,2014,4(1):6994.
20 Qu X,Wu Z,Dong W,et al.Update of IGF-1receptor inhibitor(ganitumab, dalotuzumab, cixutumumab,teprotumumab and figitumumab)effects on cancer therapy[J].Oncotargey,2017,8(17):29501-29518.
21 Gao J,Shi L Z,Zhao H,et al.Loss of IFN-γpathway genes in tumor cells as a mechanism of resistance to anti-CTLA-4therapy.[J].Cell,2016,167(2):397-404.e9.
2 Engel J,Kerr J,Schlesinger-Raab A,et al.Quality of life in rectal cancer patients[M].Modern Management of Cancer of the Rectum.Springer London,2015,238(2):349-366.
3 夏建福,周宏,方阳,等.直肠癌腹腔镜手术与开腹手术对患者凝血功能的影响[J].中国现代医生,2017,55(1):15-17.
4 Serbanescu GL,Gruia MI,Bara M,et al.The evaluation of the oxidative stress for patients receiving neoadjuvant chemoradiotherapy for locally advanced rectal cancer[J].J Med Life,2017,10(1):99-103.
5 Meng X,Li H,Kong L,et al.MRI In rectal cancer:Correlations between MRI features and molecular markers Ki-67,HIF-1α,and VEGF[J].J Magn Reson Imaging,2016,44(3):594-600.
6 Zhen Y,Xiao R,Shi H,et al.Efficacy meta-analysis of laparoscope-assisted transanal total mesorectal excision and conventional laparoscopic excision for rectal cancer[J].J Gastrointesy Surg,2016,19(6):702-707.
7 李震寰,黄晓方,詹宜.腹腔镜直肠癌根治术对患者胃肠功能及疼痛状态相关血清指标的表达影响[J].湖南师范大学学报(医学版),2016,13(6):26-28.
8 中华人民共和国卫生和计划生育委员会医政医管局.中国结直肠癌诊疗规范(2015版)[J].中华消化外科杂志,2015,14(10):783-799.
9 Atallah S.Transanal minimally invasive surgery for total mesorectal excision[J].Minimally Invasive Therapy,2014,23(1):10-16.
10 姚宏伟,刘荫华.基于循证医学证据的腹腔镜直肠癌手术疗效评价[J].中华外科杂志,2017,55(1):28-31.
11 王国森,周建平,盛伟伟,等.手辅助腹腔镜、腹腔镜辅助和开腹结直肠癌手术近期疗效的比较[J].中国医科大学学报,2017,46(2):126-130.
12 Nowak M,Królak NK,Sobolewska WA,et al.Elevated riskof venous thromboembolic events in patients with inflammatory myopathies[J].Vasc Health Risk Manag,2016,12:233-238.
13 Qi Y,Fu J.Research on the coagulation function changes in non small cell lung cancer patients and analysis of their correlation with metastasis and survival.[J].J BUON,2017,22(2):462-467.
14 于佳弘,于雪娇,杜晓雪,等.D-D、FIB、PLT等凝血功能指标与肺癌患者外周血CTC及病理特征的相关性研究[J].肿瘤药学,2017,7(5):596-599.
15 Kramer PA,Chacko BK,Ravi S,et al.Hemoglobinassociated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients[J].Lab Invest,2015,95(2):132-141.
16 Broxton CN,Culotta VC.SOD enzymes and microbial pathogens:surviving the oxidative storm of infection[J].Plos Pathog,2016,12(1):e1005295.
17 Traore BB,Kamsu-Foguem B,Tangara F.Integrating MDA and SOA for improving telemedicine services[J].Telemat Inform,2016,33(3):733-741.
18 Chen L,Li S,Guo X,et al.The role of GSH in microcystin‐induced apoptosis in rat liver:Involvement of oxidative stress and NF-κB[J].Environ Toxicol,2016,31(5):552-560.
19 Kim A,Im M,Yim N H,et al.Reduction of metastatic and angiogenic potency of malignant cancer by Eupatorium fortunei via suppression of MMP-9activity and VEGF production[J].Sci Rep-UK,2014,4(1):6994.
20 Qu X,Wu Z,Dong W,et al.Update of IGF-1receptor inhibitor(ganitumab, dalotuzumab, cixutumumab,teprotumumab and figitumumab)effects on cancer therapy[J].Oncotargey,2017,8(17):29501-29518.
21 Gao J,Shi L Z,Zhao H,et al.Loss of IFN-γpathway genes in tumor cells as a mechanism of resistance to anti-CTLA-4therapy.[J].Cell,2016,167(2):397-404.e9.