直肠系膜切除术对直肠癌根治术后局部复发患者MMPs、CEA、CA199及生存率的影响

目的:探讨直肠系膜切除术对直肠癌根治术后局部复发患者血清基质金属蛋白酶、肿瘤标志物(CEA、CA199)及生存率的影响。方法:收集直肠原发癌位于直肠中下段的病例,行直肠癌根治术复发再入院患者48例(均为本院2010年4月-2014年3月手术后的病例),按照手术方式的不同分为2组,分别24例。对照组采用姑息性手术治疗,研究组采用直肠系膜切除术治疗,采用ELISA法测定血清MMP-2、MMP-9、CEA、CA199水平,记录所有患者术后并发症状况,术后进行随访时间为3年,比较两组1年、3年的生存率状况。结果:对照组在手术时间、出血量、住院时间上高于研究组,(P0.05);对照组在肛门排气时间上低于研究组,(P0.05);与治疗前比较,两组患者治疗2周后MMP-2、MMP-9表达水平降低,治疗2周后血清CEA、CA199表达水平降低(P0.05);与对照组比较,研究组患者治疗2周后MMP-2、MMP-9表达水平较低,治疗2周后血清CEA、CA199表达水平较低(P0.05);两组患者治疗期间并发症无差异(P0.05);两组间术后1年生存率,无差异(P0.05);研究组术后3年生存率(66.67%)高于对照组(37.50%),(P0.05)。结论:直肠系膜切除术可提高直肠癌根治术后局部复发患者的长期生存率,降低血清MMP-2、MMP-9、CEA、CA199水平,安全性高,值得广泛推广。

Effect of Mesorectal Excision in Treatment of Local Recurrence after Radical Resection of Rectal Cancer on Serum Levels of MMPs, CEA and CA199 and Survival Rate

ABSTRACT Objective: To investigate the effect of mesorectal excision in the treatment of Local recurrence after radical resection of rectal cancer on serum MMPs, CEA, CA199 and survival rate. Methods: 48 patients with Local recurrence after radical resection of rectal cancer, who were under operation in our hospital from 2010.4- 2014.3, were selected and randomly divided in 2 groups, respectively 24 cases. The control group was treated with palliative surgery, and the study group was treated with TME, levels of MMP-2, MMP-9, CEA and CA199 were detected by ELISA, postoperative complications were recorded, and all patients were followed up for 3 years, the survival rates of the patients were compared with 1 years and 3 years. Results: Compared with the control group, the operation time, blood loss and hospitalization time were lower in the study group(P<0.05), compared with before treatment, levels of MMP-2, MMP-9 in 2 groups decreased after 2 weeks treatment, levels of serum CEA, CA199 expression decreased(P<0.05), compared with the control group, levels of MMP-2 and MMP-9 in the study group were lower after 2 weeks treatment, levels of serum CEA and CA199 were lower(P<0.05), there was no difference in the complications between the two groups (P>0.05) and there was no difference in survival rate between the two groups after the operation in the last 1 years(P>0.05) , but 3 year survival rate of the study group (66.67%) was higher than that of the control group (37.50%), (P<0.05). Conclusion: Mesorectal excision can improve the long-term survival rate of patients with local recurrence after radical resection of rectal cancer, reduce serum levels of MMP-2, MMP-9, CEA, CA199 with high safety, and it is worthy of extensive promotion.