加速康复外科联合腹腔镜对高龄结直肠癌患者手术后免疫功能的影响

Effect of fast track surgery on immune function after laparoscopic operation for elderly patients with colorectal cancer

目的:观察加速康复外科(fast track surgery,FTS)联合腹腔镜结直肠癌根治术后高龄患者免疫功能的变化。方法:将61例65岁以上腹腔镜结直肠癌根治术的患者随机分为两组,Ⅰ组应用传统围手术期处理措施行腹腔镜手术(n=30),Ⅱ组应用FTS理念行腹腔镜手术(n=31)。两组患者分别于术前1天、术后第3天、术后第7天取外周血测定C反应蛋白(C reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、免疫球蛋白(IgA、IgM、IgG)及T细胞亚群(CD4+、CD8+和CD4+/CD8+比值)。结果:两组患者术后第3天、第7天CRP、IL-6均较术前明显升高(P<0.05),但Ⅰ组升高更明显(P<0.05)。术后第3天,两组患者免疫球蛋白均较术前降低(P<0.05),Ⅰ组的IgM含量下降更明显(P=0.002);术后第7天,两组患者免疫球蛋白含量均恢复至术前水平。两组患者术后第3天T细胞亚群含量较术前降低(P<0.05),Ⅰ组下降更明显(P=0.03,P=0.024,P=0.002),术后第7天,Ⅱ组已恢复至术前水平,但Ⅰ组CD8+含量仍低于术前(P=0.008)。结论:高龄结直肠癌患者应用FTS理念行腹腔镜手术对机体的免疫功能影响相对更小,值得推广应用。

Objective： To investigate the influence of fast track surgery（ FTS） on the immune function after laparoscopic operation for elderly patients with colorectal cancer. Methods： Sixty-one patients older than 65 years with colorectal cancer were randomized to receive traditional protocol and laparoscopic surgery（ group Ⅰ,n = 30）,FTS and laparoscopic surgery（ groupⅡ,n = 31）. C reactive protein（ CRP）,interleukin-6（ IL-6）,CD4＋,CD8＋,CD4＋/CD8＋,IgA,IgM,IgG were tested 1 d before operation,3 and 7 d after operation. Results： On the postoperative 3rd and 7th day,CRP and IL-6 significantly increased as compared to preoperative data in two groups（ P〈 0. 05）,but the parameters in group Ⅰ were significantly higher than those in group Ⅱ（ P〈 0. 05）. On the postoperative3 rd day,IgA,IgM and IgG significantly decreased as compared with preoperative data in two groups（ P〈 0. 05）,and IgM in group Ⅰwas significantly lower than that in group Ⅱ（ P = 0. 002）. On the postoperative 7 th day,there were no significant differences in IgG,IgM and IgA between before and after operation. On the postoperative 3rd day,CD4^＋,CD8^＋and CD4^＋/CD8^＋significantly decreased as compared with preoperative data in two groups（ P〈 0. 05）,and the parameters in group Ⅰ were significantly lower than those in group Ⅱ（ P = 0. 03,P = 0. 024,P = 0. 002）. On the postoperative 7th day,there were no significant differences of CD4＋,CD8＋and CD4＋/CD8＋between before and after operation in group Ⅱ,but CD8＋in group Ⅰ was still lower than preoperative parameter（ P= 0. 008）. Conclusions： FTS and laparoscopic operation have fewer influences on immune function of elderly patients with colorectal cancer,and are worth popularization.