全胃切除与近端胃切除的营养和免疫效果比较

Comparison of nutrition status and immune function after total and proximal gastrectomy on proximal gastric cancer

目的通过与近端胃大部切除术后营养状况及免疫功能的比较,探讨胃上部癌行全胃切除的可行性。方法将24例胃上部癌患者分为全胃切除组(简称全切组,n=12)及近端胃大部切除组(简称近切组,n=12),并术后随访6个月,对两组病例术后的营养状况及免疫功能进行对比分析。结果两组术后第1天体质量、血红蛋白、血浆总蛋白、白蛋白、前白蛋白及IgG、IgM、IgA、CD3+、CD4+、CD4+/CD8+比值均下降,CD8+升高,但差异无统计学意义(P>0.05);术后14 d两组间前白蛋白、IgG、IgA、CD3+、CD4+、CD4+/CD8+比值比较差异有统计学意义(P<0.05),IgM比较有高度显著性统计学意义(P<0.01);术后1个月及6个月两组间各指标比较均无统计学意义(P>0.05)。结论全胃切除"P"-Roux-en-Y代胃术式是一种较好的消化道重建方式,对于术后的营养及免疫功能维持并不困难。

Objective To compare the nutrition status and immune function after total and proximal gas- trectomy on patients with proximal gastric cancer. Methods 24 cases with proximal gastric cancer were randomly divided into total gastrectomy group （TG group, N = 12） and proximal gastrectomy group （PG group, N = 12 ）. The nutrition status and immune function were compared between the two groups after 6 - month follow - up. Results The body weight, Hb, total plasma protein, albumin, prealbumin, IgG, IgM, IgA, CD3＋, CD4＋ and CD4＋/ CD8 ＋ ratio decreased on 1 st day of pest - operation, and there was no significant difference between the two groups. But the prealbumin, IgG, IgM, IgA, CD3 ＋ , CD4 ＋ and CD4 ＋/CD8＋~ ratio in PG group were higher than those in TG group on 14th day of post - operation （ p 〈 0.05）. These parameters did not chang significantly between the two groups on 1 st and 6th month of post - operation. Conclusion Total gastrectomy of ＂P＂ - Roux - en - Y stomach surgery is a good method of digestive tract reconstruction, and it is not difficult to maintain the nutrition status and immune function after surgery.