新辅助化疗结合肠内营养制剂支持对胃癌患者术前的影响研究

The new adjuvant chemotherapy combined with research on the effects of patients with gastric cancer before operation of the nutrition supportenteral

目的探讨新辅助化疗结合肠内营养制剂支持治疗对胃癌患者免疫功能及营养状况的改善作用,为临床实施胃癌切除术做准备。方法按照就诊顺序将本院普外科收治的50例胃癌患者分为治疗组和对照组,每组各25例,对照组患者采用新辅助化疗方法(m FOLFOX6),治疗组患者在对照组基础上加用肠内营养制剂。两组患者治疗3个疗程后实施胃癌切除术。观察两组患者治疗前与治疗3个疗程后免疫指标、营养学指标改善情况及不良反应发生情况。结果治疗前两组患者CD4、CD8、CD4/CD8、自然杀伤(NK)细胞水平比较差异均无显著性(P>0.05);治疗组患者治疗前后上述指标比较差异具有显著性(P<0.05),对照组患者治疗前后上述指标差异无显著性(P>0.05);治疗组患者治疗后CD4、CD4/CD8、NK细胞水平明显高于对照组,CD8细胞水平明显低于对照组,差异均具有显著性(P<0.05);治疗前两组患者总蛋白、清蛋白、前清蛋白、转铁蛋白、血红蛋白、体重比较差异均无显著性(P>0.05);仅治疗组患者治疗前后NPS评分具有显著性差异(P<0.05),其他营养学指标差异均无显著性(P>0.05);治疗后治疗组患者总蛋白、清蛋白、前清蛋白、转铁蛋白、血红蛋白、NPS评分、体重均明显高于对照组,差异均具有显著性(P<0.05);治疗组患者食欲不振、进食哽咽、腹胀、恶心等不良反应发生率均显著低于对照组,差异均具有显著性(P<0.05)。结论胃癌患者术前采用新辅助化疗结合肠内营养制剂支持治疗有利于增强免疫水平,改善营养状况和化疗耐受性,为手术做好准备,对缓解患者病情,提高生活质量具有重要意义,值得临床推广应用。

Objective To evaluate the effect of neoadjuvant chemotherapy combined with enteral nutrition support treatment for improving the effect on immune function and nutritional status in patients with gastric cancer, gastric resection for clinical implementation preparation. Method According to the order of treatment to 50 cases of gastric cancer patients in our hospital department of general surgery were divided into treatment group and control group, 25 cases in each group. Control group were treated with neoadjuvant chemotherapy（mFOLFOX6）, patients in treatment group based on control group, were given enteral nutrition preparation.. Two groups of patients after three courses of treatment implemented gastric resection. Observed two groups before treatment and after treatment of 3 courses of immune index, nutrition indicators improved conditions and the occurrence of adverse reactions. Result Two groups of patients before treatment CD4, CD8, CD4/CD8, natural killer（NK） cells levels showed no significant difference（P 〉0.05）; patients treated before and after treatment of these indicators were significant differences（P〈0.05）, control group of patients before and after treatment showed no significant（P 〉0.05）; treatment group patients CD4, CD4/CD8, NK cells levels were significantly higher, CD8 cells were significantly lower than control group, and the differences were statistically significant（P〈0.05）; total protein, albumin, prealbumin, transferrin, haemoglobin, weight, in two groups before treatment had no significant difference（P〉0.05）; before and after treatment, patients in treatment group had significant differences in NPS score（P〈0.05）, other nutritional indicators showed no significant difference（P〉0.05）; after treatment, total protein, albumin, prealbumin, transferrin, hemoglobin, NPS score, body weight in treatment group were significantly higher than control group, the differences were statistically significant（P〈0.05）; appetite, eating choked, bloating, nausea and other adverse events in treatment group were significantly lower than control group, the differences were statistically significant（P〈0.05）. Conclusion Patients with gastric cancer before neoadjuvant chemotherapy combined with enteral nutrition support treatment is beneficial to the enhancement of immune level, improve the nutritional status and chemotherapy tolerance, ready for operation, to alleviate symptoms in patients, which is of great significance in improving the quality of life, worthy of clinical application.