FTS理念对胃癌腹腔镜术后病人免疫功能影响

EFFECT OF FAST TRACK SURGERY ON IMMUNE FUNCTION AFTER LAPAROSCOPIC SURGERY FOR PATIENTS WITH GASTRIC CANCER

目的探讨加速康复外科（FTS）理念对行腹腔镜胃癌根治术病人术后免疫功能影响。方法 2012年10月—2014年10月,于青岛大学附属医院普通外科选择因远端胃癌行腹腔镜下根治性远端胃切除术的病人80例,随机分为FTS组和对照组。FTS组采用FTS理念指导围手术期处理,对照组给予传统的围手术期处理。比较两组病人术后1、3dC反应蛋白（CRP）、白细胞介素6（IL-6）、免疫球蛋白（IgA、IgG、IgM）以及T细胞亚群（CD3^＋、CD4^＋T细胞及CD4^＋/CD8^＋）水平。结果两组病人术前各指标差异均无显著性（P〉0.05）。术后1d,两组病人CRP水平均较术前增高,但FTS组低于对照组（t=2.032,P〈0.05）。术后1、3d,两组病人IL-6水平均高于术前,但FTS组低于对照组（t=2.248、2.368,P〈0.05）。术后1、3d,两组病人IgM水平均较术前下降,对照组下降更为明显（t=2.832、2.444,P〈0.05）。术后1、3d,两组病人CD3^＋和CD4^＋T细胞、CD4^＋/CD8^＋均明显低于术前,除术后3dCD3^＋T细胞外,对照组下降更为明显（t=2.152-4.744,P〈0.05）。结论应用FTS理念指导腹腔镜手术,能够减轻胃癌病人术后炎症反应,保护机体的免疫功能,可能对病人的术后康复及预后起到积极作用。

Objective To investigate the effect of fast track surgery（FTS）on immune function in patients after laparoscopic radical resection for gastric cancer. Methods During October 2012—October 2014,80 patients undergoing laparoscopic radical gastrectomy for distal-end gastric cancer in our department were enrolled in this study,the patients were randomized to FTS group and control group.The patients in the FTS group received perioperative FTS care,and those in the control group were offered conventional care.The levels of CRP,IL-6,IgA,IgG,IgM,CD3^＋,CD4^＋,and CD4^＋/CD8^＋were detected,before and one and three days after surgery.The results were compared between the two groups. Results There were no significant differences in all the parameters between the two groups before operation（P〉0.05）.One day after surgery,CRP in both groups was higher than before surgery,but that in the FTS group was lower than that in the control group（t=2.032,P〈0.05）.One and three days after surgery,the findings of several parameters were as follows：IL-6in both groups was higher than before surgery,but that in the FTS group was lower versus the control（t=2.248,2.368;P〈0.05）;IgM level in both groups was lower than before surgery,but that in the control group was much lower（t=2.832,2.444;P〈0.05）;CD3^＋,CD4^＋and CD4^＋/CD8^＋decreased significantly in both groups,that in the control group were much obvious,except CD3^＋three days after surgery（t=2.152-4.744,P〈0.05）.Conclusion Applying fast-track surgery philosophy to guide laparoscopic surgery can relieve postoperative inflammatory reaction in patients undergoing surgery for gastric cancer,protect patient＇s immune function,and play an active role in rehabilitation and prognosis.