腹腔镜胃癌根治术对进展期胃癌的应激、免疫变化及并发症的影响

Study on stress,immune changes and complications of laparoscopic radical gastrectomy for advanced gastric cancer

目的研究腹腔镜胃癌根治术对进展期胃癌患者应激、免疫功能及并发症发生率的影响。方法选取2014年8月至2017年2月76例进展期胃癌患者为研究对象,按随机数表法分为观察组与对照组,各38例。观察组采取腹腔镜胃癌根治术,对照组常规开腹行胃癌根治术,比较两组术前、术后1、4、7 d应激指标白细胞(WBC)、C反应蛋白(CRP)、白细胞介素(IL)-6水平及免疫功能CD4^+、CD8^+,CD4^+/CD8^+的差异,记录术后并发症发生率。选择术后1 d应激指标,绘制WBC、CRP、IL-6预测术后并发症的ROC曲线。结果两组术后1 d WBC、CRP、IL-6与术前比较均显著升高(P均<0.05);随时间推移呈降低趋势,观察组术后1、4 d WBC、CRP、IL-6均显著低于对照组(P均<0.05);术后7 d两组各应激指标比较差异无统计学意义(P均>0.05)。两组术后CD4^+、CD4^+/CD8^+呈降低趋势,CD8^+呈增高趋势,观察组术后4、7 d CD4^+、CD4^+/CD8^+显著高于对照组,CD8^+显著低于对照组(P均<0.05)。观察组术后并发症总发生率显著低于对照组(10.53%vs 31.58%,P<0.05);WBC、CRP、IL-6预测术后并发症曲线下面积分别0.876、0.761、0.718。结论与开腹手术比较,腹腔镜胃癌根治术治疗进展期胃癌,其术后应激、免疫抑制较轻,并发症风险较低。术后应激炎性指标对并发症的发生有一定预测作用,其降低可能是腹腔镜手术术后并发症发生率降低的影响因素之一。

Objective To study the influences of laparoscopic radical gastrectomy on stress,immune function and complication rate in patients with advanced gastric cancer. Methods A total of 76 patients with advanced gastric cancer were selected from August 2014 to Membery 2017 and randomly divided into observation group and control group（ n = 38 each）. The laparoscopic radical gastrectomy was conducted in observation group,while the open radical gastrectomy was performed in control group. The stress markers including white blood cell（ WBC）,C reactive protein（ CRP）,interleukin-6（ IL-6） and changes of CD4^＋,CD8^＋,CD4^＋/CD8^＋were compared before operation and at 1-,4-and 7-day after operation between two groups. The incidence of postoperative complications was recorded. The WBC,CRP and IL-6 at 1-day after operation were used to draw ROC curve to predict postoperative complications. Results The levels of WBC,CRP and IL-6 in both two groups significantly increased 1-day after operation compared with pre-operation（ all P〈0. 05）,they showed a decreasing tendency over time and were significantly lower in observation group than those in control group at 1-,4-day after operation（ all P〈0. 05）. There was no significantdifference in stress index 7 days after operation between two groups（ all P〉0. 05）. The postoperative levels of CD4^＋and CD4^＋/CD8^＋tended to decrease,and level of CD8^＋tended to increase in both two groups. Compared with control group,the levels of CD4^＋,CD4^＋/CD8^＋increased significantly,and the level of CD8^＋decreased 4 days and 7 days after surgery in observation group（ all P〈0. 05）. The incidence of postoperative complications in observation group was significantly lower than that in control group（ 10. 53% vs 31. 58%,P〈0. 05）. The area under the ROC curve of WBC,CRP and IL-6 to predict postoperative complications were 0. 876,0. 761 and 0. 718 respectively. Conclusions Compared with open surgery,laparoscopic radical gastrectomy has lighter stress and immune suppression,lower risk of complications in the treatment of advanced gastric cancer. Stress indicators have certain predictive effect for postoperative complications. The decrease of the index may be one of the factors for lower incidence of complications after laparoscopic surgery.