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find Author "晏阳" 2 results
  • Liver Function Alterations and Its Influencing Factors after Laparoscopic-Assisted Radical Gastrectomy for Gastric Cancer

    Objective To evaluate the changes of liver function after laparoscopic-assisted radical gastrectomy for gastric cancer and analyze related impact factors. Methods Patients with gastric cancer or colon cancer, who underwent radical gastrectomy or hemicolectomy between Jun 2008 and Jun 2010 in General Hospital of PLA, were included in this study. These patients were divided into open gastrectomy (OG group, n=43), laparoscopic-assisted gastrectomy (LAG group, n=35), and laparoscopic-assisted hemicolectomy (LAC group, n=23). The serum AST, ALT, TB, and ALP levels of all patients enrolled on the preoperative day and post operative day (POD) 1, POD3, POD5, and POD7, and related impact factors were analyzed. Results Compared with the preoperative results, serum AST and ALT levels of patients increased until POD5 in both LAG and OG groups (P<0.05), and there was no changes in liver function after operation of patients in LAC group (P>0.05). In addition to that serum AST and ALT levels of patients in LAG group in POD1 were significantly higher than those in OG group (P=0.035 and P=0.041), and that serum ALT level of patients in LAG group was significantly lower than that in OG group in POD3 (P=0.048), serum AST and ALT levels of patients in two groups in the remaining time points were not statistically significant difference (P>0.05). The serum AST and ALT levels of patients in LAG group were significantly higher than those in LAC group during 5 d after operation (P<0.05).There was no significant changes of serum ALP and TB levels of patients in LAG and OG groups on the before and after operation (P>0.05). The increased serum ALT level of gastric cancer patients after operation related to body mass index (BMI, P=0.038), operative time (P=0.011), intraoperative hepatic injury (P=0.035), and abnormal ligation of hepatic artery (P=0.048), instead of the type of operation (OG vs.LAG, P>0.05). Conclusions Gastric cancer patients who underwent radical gastrectomy have transient liver dysfunction, which attributes mainly to direct liver manipulation or abnormal ligation of hepatic artery, but not CO2 pneumoperitoneum. Laparoscopic-assisted radical gastrectomy is feasible and safe to the patients without serious liver damage or other vital organs disorders.

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  • TSA-DC-CTL 细胞免疫治疗联合 PD-L1 抗体治疗高龄晚期结肠癌 1 例报道并文献复习

    目的报道 1 例肿瘤特异性抗原(TSA)刺激诱导树突状细胞(DC)及细胞毒性 T 淋巴细胞(CTL)过继治疗联合程序性死亡配体 1(PD-L1)抗体治疗高龄晚期结肠癌患者。方法2018 年 2 月笔者所在医院对 1 例 90 岁高龄女性患者因“回盲部癌伴梗阻”行剖腹探查、回盲部切除、小肠部分切除、末端回肠造瘘、腹膜活检术,肿瘤广泛转移,患者基础条件差,术后无法耐受常规治疗。经与患者家属充分沟通知情同意及解放军总医院伦理委员会批准,于术后 4 个月开始行 4 次 TSA-DC 细胞皮内多点注射,4 次 TSA-CTL 细胞静脉滴注,2 次 TSA-CTL 细胞腹腔注入,1 次 PD-L1 抗体 1 200 mg 静脉滴注。结果行 TSA-DC-CTL 联合 PD-L1 治疗后 7 d(治疗中期),患者的 KPS 评分升至 80 分(治疗前 40 分),外周血循环肿瘤细胞计数降至 7 个/3.2 mL(治疗前 16 个/3.2 mL),肿瘤标志物 CA125 降至 155.5 u/mL(治疗前 224.4 u/mL),治疗过程中未见相关不良反应。行 TSA-DC-CTL 联合 PD-L1 治疗后 36 d 患者突然出现血压和血氧饱和度下降,给与升压、兴奋呼吸等治疗,情况好转,因家属要求患者自动出院。结论TSA-DC-CTL 细胞免疫治疗联合 PD-L1 治疗本例高龄患者安全可行,能在一定程度上改善患者生活质量及部分生物学指标,但 TSA-DC-CTL 联合 PD-L1 抗体的安全性及近远期疗效有待进一步研究论证。

    Release date:2019-06-05 04:24 Export PDF Favorites Scan
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