肠内免疫营养在原发性肝癌肝切除术治疗中的价值

The value of enteral immunonutrition in therapeutic hepatectomy for patients with primary liver cancer

目的:探讨原发性肝癌肝切除术围手术期实施肠内免疫营养支持对其免疫功能及预后的影响。方法:将2003年入我院行肝切除术治疗的原发性肝癌患者58例随机分为免疫营养支持组和常规营养对照组,其他处理一致。检测入院时、术后第1d和术后第7d时免疫功能;随访5年,比较两组的预后。结果:肝切除术前肝癌患者CD3+、CD4+、CD8+和CD4+/CD8+含量两组间水平相当。术后第1d,CD3+、CD4+、CD8+含量较术前明显下降;两组间没有差异。术后第7d,CD3+、CD4+、CD8+含量较术后第1d均有上升;而干预组较对照组上升更为明显。干预组和对照组1、2、3、4、5年生存率分别为82.8%、70.2%、39.6%、22.6%、20.6%和74.6%、50.1%、25.4%、21.5%、19.5%。其术后1年、2年和3年生存率干预组优于对照组,而4、5年生存率两组则相当,而2组术后总体生存干预组优于对照组(χ2=3.547,P=0.025),多因素分析调整后干预组与对照组对术后生存影响的OR值为0.649,95.0%CI为0.614～0.686。结论:肠内免疫营养支持一定程度上能改善原发性肝癌肝切除术围手术期患者的免疫抑制,并能改善术后生存。

Objective： The aim of this study was to investigate the immune function and prognosis for patients with primary hepatic cancer who implemented the perioperative enteral immunonutrition support for hepatectomy. Methods： 58 cases of patients with primary hepatic cancer in our hospital in 2003 treated with liver resection were randomly divided into nutritional support for immune nutrition group and conventional control group. Immune function was detected on admission, 1st day and 7th after surgery; 5-year follow-up was performed to compare the prognosis of the two groups. Results： Concentration level of CD3＋,CD4＋, CD8＋ and CD4＋/CD8＋ in preoperative hepatectomy were the same between the two groups. On the first day after surgery,CD3＋,CD4 ＋,CD8 ＋ content decreased significantly; there was no difference between the two groups. On the 7th day after surgery, CD3＋, CD4 ＋, CD8 ＋ content increased ; and the intervention group increased more significantly. 1,2,3,4,and 5-year survival rates in intervention group and control group were 82.8% ,70.2%, 39.6% ,22.6% ,20.6% and 74.6% ,50.1% ,25.4% ,21.5%, 19.5%. The survival rate was higher in the intervention group than the control group at 1-year, 2-year and 3-year, while the 4 and 5-year survival rate of the two groups was same, and the intervention group had better overall survival compared with the control group （χ2 = 3.547,P = 0.025）. The OR value for enteral immunonutrition support impacting postoperative survival was 0.649 after multivariate analysis adjusted, with 95.0% CI of 0.614-0.686. Conclusion：Enteral immunonutrition support can ameliorate immune suppression in hepatectomy for patients with primary liver cancer during perioperative period, and it also can improve postoperative survival.