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专家述评

肠道支架治疗梗阻性结直肠癌的治疗现状

Current status of intestinal stent therapy for obstructive colorectal cancer

:396-401
 
       约10%~30%的新发结直肠癌患者会出现急性肠梗阻,传统急诊手术治疗存在术后并发症高、死亡率高、生存质量低等不足。肠道支架置入联合限期手术作为一种新型治疗策略,展现出显著优势。肠道支架可迅速解除梗阻,改善患者症状,降低手术风险,为肿瘤微创切除创造条件,同时为新辅助化疗提供可能,但其潜在并发症如出血、移位、再梗阻及肠穿孔等也不容忽视,且长期安全性及对肿瘤结局的影响尚不明确。文章综述了肠道支架治疗梗阻性结直肠癌的治疗现状、争议及研究进展,旨在为临床研究和实践提供参考依据。
    Approximately 10% to 30% of patients with newly diagnosed colorectal cancer present with acute intestinal obstruction.Traditional emergency surgical intervention is characterized by high rates of postoperative complications,elevated mortality,and diminished quality of life.Combined stent and curative elective surgery(CSCES)has emerged as a novel therapeutic strategy,exhibiting significant clinical benefits.Intestinal stenting can rapidly alleviate obstruction,thereby improving patient symptoms,reducing surgical risks,and facilitating minimally invasive tumor resection.Additionally,it provides an opportunity for neoadjuvant chemotherapy.However,potential complications,including bleeding,stent migration,recurrent obstruction,and intestinal perforation,must be carefully considered.Moreover,the long-term safety and impact on oncologic outcomes remain to be elucidated.This review aims to provide a comprehensive overview of the current status,controversies,and recent advancements in the use of intestinal stents for the treatment of obstructive colorectal cancer,with the goalof informing clinical research and practice.
论著

腹腔镜结直肠癌根治术患者术前静脉注射艾司氯胺酮的临床效果观察

Clinical observation of preoperative intravenous injection of esketamine in patients undergoing laparoscopic radical resection for colorectal cancer

:466-471
 
      目的 探讨术前静注艾司氯胺酮在腹腔镜结直肠癌根治术患者中的应用效果。方法 前瞻性分析2024年1月—2025年4月在厦门市中医院行腹腔镜结直肠癌根治术患者的临床资料,根据随机数字表法将患者分为两组:对照组40例,术前5 min予5 mL生理盐水;观察组40例,术前5 min予以0.25 mg/kg艾司氯胺酮(以生理盐水配置成5 mL)。比较围术期指标、炎症因子、负性情绪、疼痛情况、不良反应。结果 观察组的手术时间、麻醉时间、术中出血量分别为(213.54±64.22)min、(240.67±81.26)min、(141.31±45.03)mL,与对照组的(210.43±65.71)min、(244.25±81.33)min、(137.64±42.75)mL比较,差异均无统计学意义(t=0.214、0.197、0.374,P均>0.05),而观察组丙泊酚、瑞芬太尼用量分别为(1 075.52±134.37)mg、(1 267.18±242.26)μg,虽然低于对照组的(1?126.64±150.21)mg、(1 352.50±295.14)μg,但差异也无统计学意义(t=1.604、1.413,P均>0.05);观察组在术后24 h的肿瘤坏死因子-α、白介素-6、C反应蛋白水平分别为(54.52±9.64)pg/mL、(40.08±7.75)pg/mL、(30.38±6.93)mg/L,均低于对照组的(77.31±10.86)pg/mL、(56.35±9.47)pg/mL、(43.73±7.61)mg/L(t=9.926、8.409、8.203,P均<0.05);术后1 d的焦虑、抑郁自评量表评分及术后1 h、6 h、12 h、24 h咳嗽时的疼痛视觉模拟量表评分分别为(51.92±4.41)分、(53.96±4.47)分、(3.59±1.14)分、(3.06±1.01)分、(2.89±0.91)分、(2.57±0.76)分,均低于对照组的(55.06±5.12)分、(57.21±5.19)分、(4.27±1.36)分、(3.68±1.18)分、(3.41±1.06)分、(2.96±0.92)分(t=2.939、3.001、2.423、2.525、2.329、2.067,P均<0.05),但两组术后48 h咳嗽时疼痛视觉模拟量表评分比较差异无统计学意义(P>0.05);两组术后不良反应发生率也无显著差异(P<0.05)。结论 在腹腔镜结直肠癌根治术术前静注艾司氯胺酮可有效降低术后炎症反应水平,减轻术后疼痛,缓解术后负性情绪,且不会增加患者术后不良反应发生率。

Objective To explore the application effect of preoperative intravenous injection of esketamine in patients undergoing laproscopic radical resection of colorectal cancer.Methods The clinical data of patient who underwent laparoscopic radical resection of colorectal cancer in Xiamen Hospital of Traditional Chinese Medicine from January 2024 to April 2025 were retrospectively analyzed.The patients were divided into two groups according to the random number table method:40 cases in the control group were given 5 mL saline,five minutes before operation,40 cases in the observation group were treated with 0.25 mg / kg esketamine(in 5 mL saline)five minutes before operation.The perioperative indicators,inflammatory factors,negative emotions,pain and adverse reactions were compared between two groups.Results The operation time,anesthesia time and intraoperative blood loss of the observation group were(213.54±64.22)min,(240.67±81.26)min and(141.31±45.03)mL,respectively,which were not significantly different from those of the control group(210.43±65.71)min,(244.25±81.33)min and(137.64±42.75)mL(t=0.214,0.197,0.374,all P>0.05).The dosage of propofol and remifentanil in the observation group were(1 075.52±134.37)mg and(1 267.18±242.26)μg,respectively,which were lower than those in the control group of (1126.64±150.21)mg and(1352.50±295.14)μg,but the difference was not statistically significant(t=1.604,1.413,P>0.05).The levels of tumor necrosis factor-α,interleukin-6 and C-reactive protein in the observation group at 24 h after operation were(54.52±9.64)pg / mL,(40.08±7.75)pg / mL and(30.38±6.93)mg / L,respectively,which were lower than those in the control group of (77.31±10.86)pg / ml,(56.35±9.47)pg / mL and 43.73±7.61)mg / L(t=9.926,8.409,8.203,all P<0.05).The scores of Anxiety and Depression Self-Rating Scale at 1 day after operation and the scores of pain visual analogue scale at 1 h,6 h,12 h and 24 h after operation were(51.92±4.41),(53.96±4.47),(3.59±1.14),(3.06±1.01),(2.89±0.91) and(2.57±0.76),respectively,which were lower than those of the control group(55.06±5.12),(57.21±5.19),(4.27±1.36),(3.68±1.18),(3.41±1.06) and(2.96±0.92)(t=2.939,3.001,2.423,2.525,2.329,2.067,P<0.05).However,no significant difference was observed in cough-related VAS scores between the groups at 48 h postoperatively(P>0.05).Adverse event rates showed no significance in two groups(P>0.05).Conclusions Preoperative administration of esketamine in laparoscopic colorectal cancer surgery can attenuate postoperative inflammation,decrease pain,mitigate negative emotions,without increasing the incidence of postoperative adverse reactions.
论著

补肾益气方肾俞膏摩治疗结直肠癌康复期癌因性疲乏的临床观察及疗效评价:一项随机对照试验

Clinical observation and curative effect evaluation of Shenshu Tuina combined with Bushen Yiqi herbal ointment on cancer-induced fatigue in convalescent stage of colorectal cancer

:333-340
 
       目的  观察补肾益气方肾俞膏摩治疗结直肠癌康复期癌因性疲乏的临床疗效。方法  收集2023年6月—2024年6月结直肠癌康复期的80例住院及门诊患者,随机平均分为两组。行常规对症支持治疗的为对照组;在常规对症支持治疗上加用补肾益气方肾俞膏摩的为干预组;两组均连续治疗14天。于开始治疗前1天和治疗结束后1天分别进行疗效评估相关指标检测。于治疗前1天、治疗第7天和第14天进行不良反应检测。结果 干预组治疗后Piper评分、中医证候总积分、PSQI评分、KPS评分及免疫功能指标(CD3+  、CD4+、CD8+  、CD4+ /CD8+ )较治疗前均有明显改善;干预组发生不良反应少于对照组。结论  补肾益气方肾俞膏摩治疗能够有效改善结直肠癌患者的癌因性疲乏的治疗效果,提高生活质量和免疫功能,减少不良反应。
       Objective  To observe the clinical observation of Shenshu Tuina combined with Bushen Yiqi herbal ointment in the treatment of cancer-induced fatigue in the convalescent stage of colorectal cancer and evaluate the efficacy.Methods  From June 2023 to June 2025,80 inpatients and outpatients of colorectal cancer in the  recovery period were collected and  randomly divided into two groups.The patients who received routine symptomatic supportive treatment were enrolled as the control group.The intervention group was given Shenshu Tuina combined with Bushen Yiqi herbal ointment on the basis of control group.The relevant indicators for efficacy evaluation were tested one day before treatment and one day after the end of treatment.Adverse reactions were detected on the day before treatment,theseventh day and 14th day during treatment.Results  The efficacy evaluation indexes of the intervention group after treatment were obviously improved compared with those before treatment.Adverse  reactions occurred less in the intervention group than in the control group.Conclusions  Shenshu Tuina combined with Bushen Yiqi herbal ointment can effectively improve the treatment effect of cancer-induced fatigue in patients with colorectal cancer,improve the quality of life and immune function,reduce adverse reactions.
专家综述

结直肠癌的早期诊断策略和治疗进展

Early diagnostic strategies and therapeutic advances in colorectal cancer

:1-8
 
通过筛查和早期发现,可以降低结直肠癌(CRC)的发病率,有效切除肿瘤病变可以降低CRC的病死率。虽然对CRC的危险因素、发病机制和前体病变的了解已经取得进展,但最近年轻人群CRC发病率升高,原因尚不清楚。在过去十年中,出现了多种侵入性、半侵入性和非侵入性筛查方式。目前对结肠镜检查质量的重视提高了筛查的有效性,人工智能等影像新技术在肿瘤检测中的作用正在迅速显现。而且,CRC有效干预措施,如保肛治疗新术式、靶向治疗及免疫治疗领域的新进展,被证明可以提高CRC患者的生存率。该文旨在总结目前国内外CRC筛查方式和指南的证据,并综述CRC治疗领域的进展。
The incidence of colorectal cancer(CRC)can be reduced through screening and early detection.Effective resection of tumor lesions reduces mortality from CRC.Although progress has been made in understanding the risk factors,pathogenesis and precursor lesions of CRC,the reasons for the recent increase in the incidence of CRC in young adults are largely unknown.A variety of invasive,semi-invasive and non-invasive screening modalities have emerged in the last decade.The current emphasis on the quality of colonoscopy has improved the effectiveness of screening,and the role of new imaging technologies such as artificial intelligence in tumor detection is rapidly emerging.Moreover,there are effective interventions for CRC,such as new surgical modalities for anal preservation therapy,and new advances in the field of targeted therapy and immunotherapy,which have been shown to improve the survival rate of CRC.The aim of this article is to summarize the current evidence on CRC screening modalities and guidelines both nationally and internationally,and to provide an overview of advances in the field of CRC treatment.
论著

低浓度布比卡因联合全身麻醉对腹腔镜下直肠癌根治术患者体征及苏醒质量的影响

Clinical study on the effect of low concentration bupivacaine combined with general anesthesia on the physical signs and recovery quality of patients undergoing laparoscopic radical resection of rectal cancer

:295-299
 
目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组(P<0.05);术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组(P>0.05);但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组(P<0.05);联合组的麻醉相关不良反应发生率略高于全麻组(P>0.05);随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组(P<0.05)。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。
Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects.The patients were divided into groups by drawing lots.Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group.Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation.The changes of physical signs and the quality of recovery were compared between the two groups.Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group(P<0.05).After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group(P>0.05).However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group(P<0.05).The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group(P>0.05).During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group(P<0.05). Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe.
专家综述

磁共振酰胺质子转移加权成像在直肠癌中的研究进展

Magnetic resonance amide proton transfer-weighted imaging in rectal cancer research progress

:1-9
 
直肠癌是全球常见的消化道恶性肿瘤之一,准确的影像学评估对直肠癌的诊断和治疗决策至关重要。在各种影像学检查中,磁共振成像已逐渐成为直肠癌不可或缺的检查手段,其中酰胺质子转移加权(APTw)成像是当前直肠癌磁共振成像中的一种极具发展前景的成像技术,其是通过检测病灶中内源性可移动蛋白的酰胺质子与水质子之间的交换,可以更好地在分子水平评估直肠癌病灶的蛋白质浓度、pH值、温度和代谢状态等,在直肠癌中有极大的应用潜能,有助于实现精准医疗。本文主要综述APTw成像在直肠癌中的研究进展、发展前景及尚存在的问题。
Rectal cancer is one of the most common gastrointestinal malignancies worldwide, and accurate imaging evaluation is essential for the diagnosis and treatment of rectal cancer.In various imaging examinations, magnetic resonance imaging(MRI)has gradually become an indispensable means of rectal cancer, among which amide proton transfer-weighted(APTw)imaging is a promising imaging technology.APTw imaging is to detect the exchange between amide protons of endogenous mobile proteins in lesions and water quality particles, which can better assess the protein concentration, pH, temperature, and metabolic status of rectal cancer at the molecular level.It has great application potential in rectal cancer and contributes to precision medicine.This article mainly reviews the research progress, development prospect and remaining problems of APTw imaging in rectal cancer.
论著

新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响

Effect of neostigmine antagonizing timing of cisatracurium on residual muscle relaxation and early lung function after laparoscopic radical resection of colorectal cancer

:70-74
 
目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激(TOF)比值将试验组患者分为试验组A(TOF≤0.1)、试验组B(0.10.8)。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组(P<0.01),空白对照组患者TOF比值高于其他组(P<0.01);空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义(P>0.01);试验组A患者肌松恢复指数低于其他组(P<0.01),空白对照组患者肌松恢复指数高于其他组(P<0.01)。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1/FVC比较差异无统计学意义(P>0.05)。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。
Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer.Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects.The patients were randomly divided into a blank control group and an experimental group using a random number table method.Then,combined with the train-of-four(TOF)ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A(TOF≤0.1),experimental group B(0.10.8).The residual muscle relaxation and lung function between groups were compared.Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups(P<0.01),while the TOF ratio of patients in the blank control group was higher than that of other groups(P<0.01).There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit(P>0.01).The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups(P<0.01),while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups(P<0.01).There were no significant differences in force expiratory volume in one second(FEV1),forced Vital capacity(FVC)and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation(P>0.05).Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels.
论著

基于NRS2002系统的多学科营养支持在直肠癌放化疗患者中的应用效果

Efficacy of multidisciplinary nutritional support through NRS2002 system in patients with rectal cancer undergoing radiotherapy and chemotherapy

:65-69
 
目的 评估基于NRS2002系统的多学科营养支持对直肠癌放化疗患者的作用。方法 选取2017年2月—2020年2月我院收治的96例直肠癌放化疗患者作为研究对象,根据入院建档顺序不同分2组,每组48例,对照组接受常规护理,观察组接受基于NRS2002系统的多学科营养支持。比较2组干预前后主观全面评定法(PG-SGA)评分、营养指标[前白蛋白(prealbumin, PA)、血清白蛋白(serum albumin, SA)、转铁蛋白(transferrin, TF)]、癌因性疲乏、生存质量(FLIC评分)。结果 干预后观察组营养状况优于对照组(P<0.05);干预后观察组SA、PA、TF高于对照组(P<0.05);干预后观察组癌因性疲乏低于对照组(P<0.05);干预后观察组生存质量FLIC各维度评分高于对照组(P<0.05)。结论 基于NRS2002系统的多学科营养支持有助于改善直肠癌放化疗患者营养状态,减轻癌因性疲乏,提升生存质量水平。
Objective To evaluate the efficacy of multidisciplinary nutritional support through NRS2002 system on patients undergoing radiotherapy and chemotherapy with rectal cancer. Methods From February 2017 to February 2020, 96 cases of rectal cancer patients undergoing radiotherapy and chemotherapy in our hospital were selected as the research objects, which were divided into two groups according to the order of filing, 48 cases in each group. The control group received routine nursing, and the observation group received multidisciplinary nutritional support through NRS2002 system. The PG-SGA score, nutritional indexes [prealbumin (PA), serum albumin (SA), transferrin (TF)], cancer-related fatigue and quality of life (FLIC score) were compared between two groups before and after intervention. Results After the intervention, the nutritional status of the observation group was better than that of the control group (P<0.05). The SA, PA, TF of the observation group were higher than those of the control group (P<0.05). The cancer-related fatigue of the observation group was lower than that of the control group (P<0.05), and the FLIC score of the observation group was higher than that of the control group (P<0.05). Conclusion Multidisciplinary nutritional support through NRS2002 system was helpful to improve nutritional status of patients, reduce cancer-related fatigue and improve quality of life of patients with rectal cancer undergoing radiotherapy and chemotherapy.
论著

疼痛护理对直肠癌癌痛患者不良情绪及爆发性疼痛的影响

The effect of pain nursing on the negative mood and explosive pain of patients with rectal cancer pain

:77-81
 
目的 分析疼痛护理对直肠癌癌痛患者不良情绪及爆发性疼痛的影响。方法 选取2020年4月—2020年6月我院收治的68例直肠癌癌痛患者作为研究对象,通过随机分组的方式将患者分为2组,对照组使用常规临床护理模式,观察组使用疼痛护理模式,对比2组患者的癌痛程度、不良情绪及爆发性疼痛的发生率。结果 2组患者在接受不同护理模式后,SF-MPQ评分相较于护理前出现了下降(P<0.05),其中观察组的评分与对照组比较下降(P<0.05),但护理前2组比较并无差异(P>0.05);2组患者在接受不同护理模式后,功能维度评分和总体健康评分相较于护理前出现了上升(P<0.05),且与对照组比较观察组得分升高(P<0.05),2组患者在接受不同护理模式后,症状维度评分相较于护理前降低(P<0.05),且与对照组比较观察组的评分下降(P<0.05);服药依从率对比结果显示,观察组(94.12%)的依从性优于对照组(61.76%),组间比较有差异(P<0.05);爆发性疼痛对比结果显示,观察组(8.82%)低于对照组(47.06%),组间比较有差异(P<0.05)。结论 疼痛护理可以有效应用于直肠癌癌痛患者的护理中,其不仅可以减轻患者的癌痛程度,还有利于调节患者的不良情绪,降低患者的爆发性疼痛发生率,宜广泛应用及推广。
Objective To analyze the influence of pain nursing on the negative mood and explosive pain of patients with rectal cancer pain. Methods A total of 68 patients with colorectal cancer pain in June 2020 were included as research objects, and divided into two groups by randomized grouping.Routine clinical care was applied on the control group, pain nursing was applied on the observation group.The incidence of cancer pain, negative emotions and explosive pain in both groups of patients were compared. Results After applying different care plans, two groups of patients had a significant decrease in the SF-MPQ score (P<0.05), in which the score of the observation group was significantly lower than the control group (P<0.05), however, there were no significant differences before nursing (P>0.05). Two groups of patients were significantly improving in function scoring and the overall health scoring after receiving different care modes (P<0.05), and the observation group was significantly higher than the control group (P<0.05). The symptom dimension scores were significantly lower than before accepting different care modes (P<0.05), and the control group was significantly higher (P<0.05). The comparative results of the medicinal compliance of observation group (94.12%) were better than the control group (61.76%,P<0.05); outbreak pain comparative results showed the observation group (8.82%) was significantly lower than that of the control group (47.06%,P<0.05). Conclusion Pain nursing can be effectively used in the nursing of patients with rectal cancer pain.It can not only reduce the degree of cancer pain, but also help regulate the patient's negative mood and reduce the incidence of explosive pain.It should be widely used and promoted.
论著

分层应变技术评价结直肠癌患者化疗前后左心室功能的变化

Evaluation of changes in left ventricular function before and after chemotherapy by layer-specific strain analysis

:7-12
 
目的 使用分层应变技术评价以mFOLFOX6化疗的结直肠癌患者左心室功能的变化。方法 收集30例病理确诊为结直肠癌患者,各位患者均采用mFOLFOX6(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗方案,以自身对照做研究,分别于化疗前、化疗中期、化疗后期行心脏超声检查,获取常规参数,并采集左心室心尖四腔、三腔、两腔切面、短轴二尖瓣、乳头肌、心尖切面的三维动态图像,获取左心室的心肌心内膜下、中层、心外膜下心肌的纵向应变(GLSendo、GLSmid、GLSepi)及左心室心肌心内膜下、中层、心外膜下圆周应变(GCSendo、GCSmid、GCSepi)的数值,计算△GLS(△GLS=GLSendo-GLSepi),△GCS(△GCS=GCSendo-GCSepi),并比较这些数值的绝对值在化疗前后的变化。结果 无论化疗前还是化疗后,各层心肌均有跨壁梯度的存在。与化疗前相比:化疗后各层心肌应变参数的绝对值均降低,GLSendo和GCSendo、ΔGLS下降更为显著(P<0.05),其中,GLSendo的ROC曲线下面积为0.766,P<0.001,选25.3%为诊断界点,灵敏度为83.3%,特异度为70%;ΔGLS的ROC曲线下面积为0.749,P<0.001,选4.1%为诊断界点,灵敏度为76.7%,特异度为73.3%。结论 心肌分层应变技术有助于早期发现mFOLFOX6致结直肠癌患者左心室各层心肌功能的变化,GLSendo、ΔGLS是该技术中较为敏感的指标。
Objective To evaluate the changes of left ventricular function in patients with colorectal cancer treated with mFOLFOX6 using layer-specific strain analysis. Methods The data of 30 patients with pathologically diagnosed with colorectal cancer were collected. All patients were treated with mFOLFOX6 (5-fluorouracil+oxaliplatin+calcium leucovorin) chemotherapy. The self-control study was carried out before, during, and after chemotherapy, and cardiac ultrasound was performed to obtain conventional parameters, and three-dimensional dynamic images of the left ventricular apex four-chamber, three-chamber, two-chamber section, short-axis mitral valve, papillary muscle, and apical sectionare were acquired. The longitudinal strain of the three layer of myocardium (GLSendo、GLSmid、GLSepi) and the circumferential strain of myocardium (GCSendo、GCSmid、GCSepi) were collected, and △GLS (△GLS=GLSendo-GLSepi), △GCS (△GCS=GCSendo-GCSepi) were calculated, and the absolute values of these indexes before and after chemotherapy were compared. Results No matter before or after chemotherapy, there was a transmural gradient in each layer of myocardium. Compared with those before chemotherapy, the absolute values of myocardial strain parameters of each layer were reduced after chemotherapy, and GLSendo and GCSendo and ΔGLS decreased more significantly (P<0.05),while the area under the ROC curve of GLSendo was 0.766, P<0.001.Selecting 25.3% as the diagnostic boundary, the sensitivity was 83.3%, and the specificity was 70%.The area under the ROC curve of ΔGLS was 0.749, P<0.001. Selecting 4.1% as the diagnostic boundary, the sensitivity was 76.7%, and the specificity was 73.3%. Conclusions The myocardial layer-specific strain analysis is helpful for early detection of changes in the myocardial function of the left ventricle, which caused by mFOLFOX6 in patients with colorectal cancer. GLSendo and ΔGLS are sensitive indicators in this technique.
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