应用颈阔肌肌皮瓣联合重组人p53腺病毒注射液治疗牙龈癌患者的效果及对MMP-9、TIMP-1、VEGF表达的影响

目的观察应用颈阔肌肌皮瓣联合重组人p53腺病毒注射液治疗牙龈癌患者的效果及对基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制因子1(TIMP-1)、血管内皮生长因子(VEGF)表达的影响。方法采用回顾性研究的方法,选取2015年4月至2017年8月唐山市协和医院口腔科手术室收治的应用颈阔肌肌皮瓣联合重组人p53腺病毒注射液配合手术治疗的牙龈癌,且检测肿瘤已侵犯邻近组织的72例患者作为颈阔组;再抽取同样符合牙龈癌,且检测肿瘤已侵犯邻近组织的应用其他皮瓣修复配合手术治疗的68例患者作为其他组。观察两组牙龈癌患者的肿瘤细胞因子水平,基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制因子1(TIMP-1)和血管内皮生长因子(VEGF)阳性表达率,术后并发症发生率,以及肿瘤治疗效果。结果①肿瘤细胞因子水平:两组患者术后白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)与肿瘤坏死因子-α(TNF-α)水平与术前相比,均明显降低,且颈阔组降低幅度大于其他组,差异均有显著性(P<0.05)。②MMP-9、TIMP-1和VEGF阳性表达率:颈阔组患者术后MMP-9 (8.33%)、TIMP-1 (31.94%)与VEGF (13.89%)阳性表达率明显低于其他组的MMP-9 (30.88%)、TIMP-1 (48.53%)与VEGF (54.41%),差异有显著性(P<0.05)。③术后并发症发生率:颈阔组患者的术后并发症总发生率7(9.72%)例与其他组患者13(19.12%)例相比,无显著差异(P>0.05)。④肿瘤治疗效果:颈阔组治疗的总有效率(95.82%)明显高于其他组(79.41%),差异有显著性(P<0.05)。结论应用颈阔肌肌皮瓣联合重组人p53腺病毒注射液治疗牙龈癌患者的临床疗效显著,成功抑制了肿瘤的继续发展,且不良反应少,安全性较高。

Effect of platysma myocutaneous flap combined with recombinant human p53 adenovirus injection for the treatment of gingival cancer and its effect on the expression of MMP-9,TIMP-1,VEGF

Objective To observe the clinical effect of platysma myocutaneous flap combined with recombinant human p53 adenovirus injection for the treatment of gingival cancer and its effect on the expression of MMP-9,TIMP-1,VEGF.Methods 72 patients with gingival cancer invading adjacent tissues who were treated with platysma myocutaneous flap combined with recombinant human p53 adenovirus injection in our hospital from April 2015 to August 2017 were selected retrospectively as the platysma group.68 patients with gingival cancer invading adjacent tissues who were treated with other flaps combined with surgical treatment were selected as the other group.The levels of tumor cytokines,the positive expression rates of matrix metalloproteinase-9(MMP-9),tissue inhibitor of metalloproteinase-1(TIMP-1)and vascular endothelial growth factor(VEGF),the incidence of postoperative complications,and the effect of tumor treatment of the two groups were observed.Results①Tumor cytokines: The levels of interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)after operation in both groups were significantly lower than those before operation,and the decrease in the platysma group was greater than that in the other group,and the difference was statistically significant(P<0.05).②Positive expression rate of MMP-9、TIMP-1和 VEGF: The positive expression rates of MMP-9(8.33% vs.30.88%),TIMP-1(31.94% vs.48.53%),and VEGF(13.89% vs.54.41%)after operation in the platysma group were significantly lower than those in the other group,and the difference was statistically significant(P<0.05).③The incidence of postoperative complication: The total incidence of complication was 9.72%(7 cases)in the platysma group,and was 19.12% in the other group(13 cases),there was no statistically significant difference(P<0.05).④Tumor treatment efficacy: The total effective rate(95.82% vs.79.41%)in the platysma group was significantly higher than that in the other group,and the difference was statistically significant(P<0.05).Conclusion For the treatment of gingival cancer,the platysma myocutaneous flap combined with recombinant human p53 adenovirus injection has a significant clinical effect.It successfully suppresses the development of the tumor,and has fewer complications and higher safety.