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目的探讨老年直肠癌患者行低位前切除术中植入5-氟尿嘧啶缓释剂的安全性及治疗效果。方法分析2013年1月~2015年6月在北京友谊医院普外科行Dixon术老年直肠癌患者78例临床资料,随机分为两组。实验组43例直肠癌患者行标准根治性手术,术中腹腔内植入缓释性5-氟尿嘧啶;对照组35例,予以单纯根治手术而不植入缓释性5-氟尿嘧啶。术前及术后检测两组患者的白细胞计数、肝肾功能、营养状态指标及免疫功能指标,观察患者住院天数、并发症发生情况。结果两组患者术前白细胞计数(WBC)、肝肾功能、营养与免疫球蛋白指标比较差异无统计学意义(P>0.05)。实验组术后7 d与术前1 d比较WBC升高,差异有统计学意义(P<0.05),对照组WBC术后与术前比较,差异无统计学意义(P>0.05);两组患者术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清肌酐(Cr)、血尿素氮(BUN)较术前升高,其中实验组ALT、Cr比较差异有统计学意义(P<0.05)。术后实验组WBC、ALT、Cr较对照组指标明显升高,差异有统计学意义(P<0.05)。实验组术后7 d与术前1 d比较总蛋白(TP)、前白蛋白(PA)、免疫球蛋白A(Ig A)明显下降,差异有统计学意义(P<0.05),对照组术后与术前指标比较,差异无统计学意义(P>0.05)。实验组术后TP、PA、Ig A低于对照组,差异有统计学意义(P<0.05),其他营养状态指标和免疫球蛋白指标比较差异均无统计学意义(P>0.05)。术后实验组发热、腹泻发生率较高且腹腔引流量明显多于对照组,差异有统计学意义(P<0.05)。结论老年直肠癌患者低位前切除术中植入5-氟尿嘧啶缓释剂对患者免疫功能有一定的抑制作用,但未延长术后住院时间,具有较高的安全性,值得临床推广。
Objective To investigate the safety and therapeutic effect of 5-fluorouracil sustained-release agents in elderly patients with rectal cancer undergoing anterior resection. Methods Clinical data of 78 elderly patients with rectal cancer treated with Dixon’s general surgery at Beijing Friendship Hospital from January 2013 to June 2015 were analyzed and divided randomly into two groups. In the experimental group, 43 patients with rectal cancer underwent standard radical operation. Intraperitoneal intraperitoneal implantation of 5-fluorouracil was performed. In the control group, 35 patients were treated with radical surgery without implantation of sustained-release 5-fluorouracil. The white blood cell count, liver and kidney function, nutrition status index and immune function index of two groups were detected preoperatively and postoperatively. The days of hospitalization and complication were observed. Results There was no significant difference in preoperative white blood cell count (WBC), liver and kidney function, nutrition and immunoglobulin index between the two groups (P> 0.05). There was no significant difference between the experimental group and the preoperative WBC in the control group (P> 0.05). The WBC in the experimental group was significantly higher than that in the preoperative group (P <0.05) The levels of ALT, AST, BUN and BUN in patients after operation were significantly higher than those before operation, and there was significant difference between the two groups (P <0.05). The indexes of WBC, ALT and Cr in the postoperative experimental group were significantly higher than those in the control group (P <0.05). The levels of total protein (TP), prealbumin (PA) and immunoglobulin A (Ig A) in experimental group at 7 d after operation were significantly lower than those at 1 d after operation (P <0.05) There was no significant difference between preoperative and postoperative indexes (P> 0.05). The levels of TP, PA and IgA in the experimental group were lower than those in the control group (P <0.05). There was no significant difference in other nutritional status indexes and immunoglobulin indexes (P> 0.05). Postoperative experimental group fever, high incidence of diarrhea and abdominal drainage was significantly more than the control group, the difference was statistically significant (P <0.05). Conclusion In elderly patients with rectal cancer, 5-Fluorouracil slow-release agents are implanted in patients with low-level anterior resection, which have certain inhibitory effects on immune function, but have not prolonged postoperative hospital stay and have higher safety, which is worthy of clinical promotion.