腹腔镜与开腹直肠癌根治术患者循环肿瘤细胞水平变化及对肿瘤微转移的影响

目的 探讨腹腔镜与开腹直肠癌根治术对患者循环肿瘤细胞(CTC)水平、肿瘤微转移的影响.方法 前瞻性选取2017年7月至2020年6月琼海市人民医院收治的直肠癌患者130例,根据随机数字表法将其分为开腹组(n=65)、腹腔镜组(n=65).比较两组围手术期指标,包括手术时间、术中出血量、术后排气时间、留置尿管时间、引流管...

Changes of circulating tumor cell levels in patients undergoing laparoscopic and open radical resection of rectal cancer and their influence on tumor micrometastasis.

Objective To explore the effects of laparoscopic and open radical resection of rectal cancer on the level of circulating tumor cells( CTC) and tumor micrometastasis. Methods A total of 130 patients with rectal cancer admitted to Qionghai People’s Hospital from July2017 to June 2020 were prospectively selected divided into laparotomy group( n = 65) and laparoscopic group( n = 65) according to the random number table method. The perioperative indicators of the two groups were compared,including operation time,intraoperative blood loss,postoperative exhaust time,indwelling catheter time,drainage tube removal time,and hospital stay. The circulating tumor cell( CTC) counts before and3 months after surgery,and the positive and negative rates of CTC after surgery were observed. A positive CTC after surgery indicates the risk of tumor micrometastasis. Based on this,it was divided into risk group and no risk group. The factors affecting the risk of tumor micrometastasis were analyzed by Logistic multiple regression model. Results The intraoperative blood loss in the laparoscopic group was lower than that in the open group,and the postoperative exhaust time,indwelling catheter time,drainage tube removal time,and hospital stay were shorter than those in the open group,the differences were statistically significant( P < 0. 05). The postoperative CTC counts of the two groups were lower than those before the operation,the differences were statistically significant( P < 0. 05),but there was no statistically significant difference between the groups( P> 0. 05). The positive rate of CTC in the laparoscopic group was 12. 31%,compared with 16. 92% in the open group,the difference was not statistically significant( P > 0. 05). Logistic multiple regression analysis indicated that vascular tumor thrombus( OR = 1. 985,95% CI : 1. 200-3. 284),lymph node metastasis( OR = 4. 515,95% CI : 1. 965-10. 374),intraoperative stretch injury( OR = 3. 527,95% CI : 1. 621-7. 674) was an influencing factor for the risk of postoperative tumor micrometastasis( P < 0. 05). Conclusion Both laparoscopic and open radical resection of rectal cancer can reduce postoperative CTC counts. The two surgical methods have similar tumor micrometastasis risks,but laparoscopic surgery can further promote the recovery of body function. The risk of postoperative tumor micrometastasis is mainly related to Vascular tumor thrombus,lymph node metastasis,and intraoperative traction injury are related.