| 胡抢,孙元水,谢松.加速康复外科对腹腔镜远端胃癌根治术患者炎症反应和免疫功能的影响[J].浙江中西医结合杂志,2019,29(6): |
| 加速康复外科对腹腔镜远端胃癌根治术患者炎症反应和免疫功能的影响 |
| Effect of Fast-track surgey on Inflammatory Response and Immune Function in Patients with Laparoscopic Radical Gastrectomy HU Qiang,Yuan-shui,et al.Department of gastrointestinal surgery,Tongde hospital of Zhejiang Province,Hangzhou 310012,China; |
| 投稿时间：2018-10-25 修订日期：2019-05-20 |
| DOI： |
| 中文关键词: 胃癌 外科手术 炎症反应 免疫功能 腹腔镜 |
| 英文关键词:Gastric cancer Surgery Inflammatory reactions Immune function Laparoscope |
| 基金项目:浙江省科技厅计划项目（编号：2017F30045）；浙江省中医药管理局重点研究项目（编号：2018ZZ004） |
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| 中文摘要: |
| 目的 探讨加速康复外科对腹腔镜远端胃癌根治术患者炎症反应和免疫功能的影响；方法 收集2014年1月份至2017年12月份在浙江省立同德医院[1.病例来源]胃肠外科行腹腔镜远端胃癌根治术患者244例，按围手术期处理方法[2.分组方法]不同将患者分为FTS组和传统组，对两组患者术前和术后的炎症指标、免疫指标和术后并发症进行比较。结果 术前第1天和术后1天，两组患者免疫指标之间的差异无统计学意义，均P﹥0.05;术后第3天和第7天，FTS组中CD3+（58.33±5.17）（62.56±6.64）、CD4+（26.79±3.03）（29.01±3.83）、CD4+／CD8+（1.27±0.12）（1.49±0.24），IgA（1.73±0.18）（1.87±0.16）、IgM（0.94±0.16）（1.30±0.19）、IgG（10.20±1.44）（12.58±1.29）较传统组CD3+（51.78±5.40）（55.58±7.16）、CD4+（23.34±2.63）（25.16±2.97）、CD4+／CD8+（1.04±0.17）（1.20±0.22），IgA（1.53±0.20）（1.62±0.23）、IgM（0.70±0.27）（1.02±0.21）、IgG（8.22±1.48）（10.13±1.50）高，差异有统计学意义，均P﹤0.05；术前1天，两组患者免疫指标之间的差异无统计学意义，均P﹥0.05;术后第一天、第3天和第7天FTS组的IL-6（59.19±9.21）（19.14±8.59）（10.21±4.64）、TNF-（150.98±10.28）（125.06±15.63）（107.96±15.98）和CRP（59.41±10.72）（29.86±8.67）（9.73±4.05）较传统组IL-6（79.87±12.01）（27.69±6.69）（15.56±4.72）、TNF-（165.24±16.08）（147.56±17.99）（123.44±13.45）和CRP（72.91±8.78）（39.31±8.65）（16.37±5.41）低，差异有统计学意义，均P﹤0.05；FTS组中术后总并发症8例明显低于传统组的23例，差异有统计学意义，P﹤0.05。结论?与传统组相比较,加速康复外科能够有效降低术后炎症反应的程度和术后并发症发生率,且对机体的免疫功能影响更小，值得在临床上推广使用。 |
| 英文摘要: |
| Objective To investigate the effect of Fast-track surgey on inflammatory response and immune function in patients with laparoscopic radical gastrectomy.Methods A total of 244 patients in Tongde hospital of Zhejiang Province undergoing laparoscopic radical gastrectomy for gastric cancer from January 2014 to December 2017 were collected. The patients were divided into FTS group and traditional group according to different treatment methods according to perioperative period. The inflammatory index ,immune index and and postoperative complications were measured before and after the operation.Results There was no significant difference in immune index between the two groups on the first day before operation and one day after operation, all P>0.05;on the POD3 and POD7, the expression of CD3+（58.33±5.17）（62.56±6.64）、CD4+（26.79±3.03）（29.01±3.83）、CD4+／CD8+（1.27±0.12）（1.49±0.24），IgA（1.73±0.18）（1.87±0.16）、IgM（0.94±0.16）（1.30±0.19） and IgG（10.20±1.44）（12.58±1.29） in the FTS group was higher than CD3+（51.78±5.40）（55.58±7.16）、CD4+（23.34±2.63）（25.16±2.97）、CD4+／CD8+（1.04±0.17）（1.20±0.22），IgA（1.53±0.20）（1.62±0.23）、IgM（0.70±0.27）（1.02±0.21）and IgG（8.22±1.48）（10.13±1.50） in the traditional group, and the difference was statistically significant (P<0.05).There was no significant difference in inflammation index between the two groups on the first day before operation,on the POD1,POD3 and POD7,the expression of IL-6（59.19±9.21）（19.14±8.59）（10.21±4.64）、TNF-（150.98±10.28）（125.06±15.63）（107.96±15.98）and CRP（59.41±10.72）（29.86±8.67）（9.73±4.05） in FTS group was lower than IL-6（79.87±12.01）（27.69±6.69）（15.56±4.72）、TNF-（165.24±16.08）（147.56±17.99）（123.44±13.45） and CRP（72.91±8.78）（39.31±8.65）（16.37±5.41） in the traditional group, and the difference was statistically significant (P<0.05),The total postoperative complications in the FTS group(n=8) were significantly lower than those in the traditional group (n=23),the difference was statistically significant (P<0.05).Conclusions Fast-track surgey can effectively reduce the degree of postoperative inflammatory reaction and the incidence of postoperative complications compared with the traditional group, and has a smaller impact on the body's immune function, which is worthy of promotion in clinical practice. |
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