Elia P, Lombardo G, Delpiano C, Granello M
I Divisione Chirurgica, Ospedale Martini, Torino.
Minerva Chir. 1994 Jun;49(6):575-80.
As well as being related to the spread of the tumour, cancer patients present a state of immunodeficiency which is linked to age, malnutrition which is often present, particular in cases of cancer of the gastroenteric tract, surgery and the possibility of associated chemo- or radiotherapy. The authors studied two groups of 25 patients with colorectal cancer. In addition to antibiotic prophylaxis, group A received immunostimulating therapy with thymopentin-TP5. Group B was treated with antibiotic therapy alone. Cell-mediated immunity was checked preoperatively and after 15 days on the basis of skin reaction to 7 booster antigens (Multitest-IMC). Strictly surgical infective complications were more frequent in group B patients (28.1%) receiving antibiotic treatment alone compared to subjects in group A (21.6%). Infections in a non-surgical site were more than double in the absence of perioperative immune therapy. Of the 25 patients examined in group A, 3-4 postoperative infections and as many long-distance infections were reported, all of which resolved without sequelae within a few days. There was a greater and faster recovery of body weight in those subjects receiving thymopentin treatment in addition to antibiotic therapy. In colorectal cancer surgery antibiotic prophylaxis alone is without doubt a valid surgical antisepsis but, above all in hypoergic patients, it is significantly enhanced by perioperative treatment with thymopentin. This association reduces both postoperative infectious complications, in particular postoperative abdominal abscess, and infections in other areas, such as respiratory complications.
除了与肿瘤扩散有关外,癌症患者还存在免疫缺陷状态,这与年龄、常出现的营养不良(尤其是胃肠道癌症病例)、手术以及联合化疗或放疗的可能性有关。作者研究了两组各25例结直肠癌患者。除抗生素预防外,A组接受胸腺五肽(TP5)免疫刺激治疗。B组仅接受抗生素治疗。根据对7种加强抗原(多重试验-IMC)的皮肤反应,在术前和术后15天检查细胞介导的免疫。与A组患者(21.6%)相比,仅接受抗生素治疗的B组患者(28.1%)发生严重手术感染并发症的频率更高。在没有围手术期免疫治疗的情况下,非手术部位的感染增加了一倍多。在A组检查的25例患者中,报告了3 - 4例术后感染和同样数量的远距离感染,所有这些感染在几天内均无后遗症地得到解决。除抗生素治疗外,接受胸腺五肽治疗的患者体重恢复更快且更明显。在结直肠癌手术中,仅使用抗生素预防无疑是一种有效的手术防腐措施,但最重要的是,在免疫功能低下的患者中,围手术期使用胸腺五肽治疗可显著增强其效果。这种联合治疗既能减少术后感染并发症,特别是术后腹部脓肿,也能减少其他部位的感染,如呼吸道并发症。