术前免疫营养加化疗在胃肠肿瘤治疗中的应用价值

Application of Preoperative lmmunoenhancement Nutrient Therapy plus Chemotherapy in Treatment of Gastrointestinal Carcinoma

为探讨术前免疫营养加化疗对胃肠肿瘤患者近期疗效及预后的影响，将86例胃肠肿瘤患者分成两组，治疗组45例，术前实施免疫营养加化疗共7～14d，免疫营养采用肠外营养及肠内营养，营养状况好转后行化疗5～7d，休息1～2周行手术治疗。对照组41例，术前一般营养支持后即行手术治疗。术后两组均给予一般营养支持及化疗。入院时、手术前1天、术后第1天、第9天分别测蛋白及免疫指标，术后随访3～5年。结果显示，入院时两组各项指标无显著性差异，手术前1天、术后第9天，治疗组白蛋白、前白蛋白、转铁蛋白及免疫指标IgG、IgA、IgM和CD4、CD8、CD4／CD8均高于对照组（P〈0．05），手术切除率、术后3年、5年生存率治疗组明显高于对照组（P〈0．01）。结果表明，术前免疫营养加化疗能改善肿瘤患者营养及免疫状况，提高手术切除率，延长无瘤生存期，改善预后。

The objective of the study was to evaluate the efficacy of preoperative immunoenhancement nutrient therapy plus chemotherapy on the short-term therapeutic results and prognosis of the patients with gastrointesinal carcinoma. Eighty six cases with gastrointestinal tumors were divided into two groups,the trial group（45 cases） and the controlled group（41 cases）. Patients in the trial group firstly received immunoenhancement nutrient therapy, both enteral nutrition and parenteral nutrition for 7-14 days,then chemo therapy followed for 5-7days. Surgical operation was performed 1-2 weeks after chemotherapy. While patients in the controlled group received general nutrient support, then surgical treatment followed. General nutrient support and chemotherapy were given postoperatively in both groups. Indexes of proteins and immunity were measured at admission,on the previous day of surgical operation,on the first day after surgical operation and on the 9th day after surgical operation. Postoperative follow up was 3-5 years. As results, there was no marked difference in these indexes in the two groups at admission,while albumin,prealbumin, transferrin as well as IgG,IgA, IgM and CD4, CDS, CD4/CD8 in the trial group were higher than those in the controlled group measured on the previous day of surgical operation and on the 9th day after operation （P 〈0.05）and resection rate, the postoperative 3-year survival rate and 5-year survival rate were all higher in the trial group than those in the controlled group（ P 〈0.01）. It is concluded that immunoenhancement nutrient therapy plus chemotherapy can improve patients nutrition and immunity status, enhance the resection rate, prolong tumor-free survival period and improve prognosis.