腹腔镜远端胃大部切除术对进展期胃癌患者血清白细胞介素2、4的影响

Effects of laparoscopic distal gastrectomy on serum IL-2 and IL-4 levels in patients with advanced gastric cancer

目的 探讨腹腔镜远端胃大部切除术对进展期胃癌患者血清白细胞介素2（IL-2）和白细胞介素4（IL-4）的影响.方法 142例进展期胃癌患者按照随机数字表法分为观察组和对照组,每组71例.对照组采用开腹手术治疗,观察组采用腹腔镜治疗.记录两组手术时间、术中出血量、手术切口长度、淋巴结清扫个数、术后疼痛评分、术后平均住院日等;术前、术后24 h、术后36 h、术后72 h分别测定患者的血清IL-2和IL-4.结果 对照组手术时间、术中出血量、手术切口长度、淋巴结清扫个数、术后肛门排气时间、术后疼痛评分、术后平均住院日分别为（141.3±29.7）min、（177.6±26.8）mL、（13.2±2.8）cm、（18.1±2.6）个、（5.9±1.6）d、（8.5±2.0）分、（15.9±3.3）d;观察组分别为（196.4±31.6）min、（100.7±21.3）mL、（5.9±1.6）cm、（17.9±2.8）个、（3.0±1.1）d、（5.2±1.6）分、（10.5±1.9）d.观察组手术时间明显长于对照组（t=3.264,P〈0.05）;术中出血量、手术切口长度、术后肛门排气时间、术后疼痛程度评分、术后平均住院日方面,观察组明显优于对照组（t=4.779、4.069、2.916、6.904、3.142,均P〈0.05）;两组手术中淋巴结清扫个数差异无统计学意义（t=1.076,P〉0.05）.对照组血清IL-2术前、术后24 h、术后36 h、术后72 h分别为（87.26±4.63）μg/mL、（51.26±3.31）μg/mL、（62.18±4.08）μg/mL、（71.66±3.81）μg/mL;观察组分别为（87.01±3.91）μg/mL、（69.82±3.09）μg/mL、（80.14±4.24）μg/mL、（82.26±3.47）μg/mL.两组术前血清IL-2差异无统计学意义（t=0.548,P〉0.05）;术后血清IL-2均明显降低,并且在术后24 h、术后36 h、术后72 h观察组血清IL-2均明显高于对照组（t=3.926、4.867、3.019,均P〈0.05）.两组术前血清IL-4无明显差异（t=0.416,P〉0.05）;术后血清IL-4均明显降低,并且在术后24 h、术后36 h、术后72 h观察组血清IL-4均明显高于对照组（t=4.012、4.114,3.726,均P〈0.05）.结论 腹腔镜远端胃大部切除术对进展期胃癌患者创伤较小,对患者免疫抑制较轻,有利于患者术后恢复.

Objective To study the effects of laparoscopic distal gastrectomy on serum interleukin-2（IL-2） and interleukin-4（IL-4） levels in patients with advanced gastric cancer.Methods 142 patients with advanced gastric cancer were randomly devided into the control group（71 cases） and the observations group（71 cases） according to the table.The control group was treated with open surgery,while the observation group was treated with laparoscopy.The operation time,intraoperative blood loss,incision length,number of lymphnode dissection,postoperative pain score,average postoperative hospital stay were recorded in the two groups.The serum IL-2 and IL-4 levels were measured before operation and 24 h,36 h after operation.Results The operation time,intraoperative blood loss,incision length,number of lymph node dissection,postoperative anal exhaust time,postoperative pain score,postoperative hospitalization days of the control group were （141.3±29.7）min,（177.6±26.8）mL,（13.2±2.8）cm,（18.1±2.6）,（5.9±1.6）d,（8.5±2） and （15.9±3.3）d,respectively,which of the observation group were （196.4±31.6）min,（100.7±21.3）mL,（5.9±1.6）cm,（17.9±2.8）,（3.0±1.1）d,（5.2±1.6） and （10.5±1.9）d,respectively.The operation time of the observation group was significantly longer than that of the control group （t=3.264,P〈0.05）.The amount of intraoperative blood loss,incision length,postoperative anal exhaust time,postoperative pain score,average postoperative hospital stay of the observation group were significantly less than those of the control group （t=4.779,4.069,2.916,3.142,6.904,all P〈0.05）.There was no significant difference in the number of lymph node dissection between the two groups （t=1.076,P〉0.05）.In the control group,the IL-2 levels of preoperation and 24h,36h,72h postoperation were （87.26±4.63）μg/mL,（51.26±3.31）μg/mL,（62.18±4.08）μg/mL,（71.66±3.81）μg/mL,respectively,which of the observation group were （87.01±3.91）μg/mL,（69.82±3.09）μg/mL,（80.14±4.24）μg/mL and （82.26±3.47）μg/mL,respectively.There was no significant difference in serum IL-2 level between the two groups （t=0.548,P〉0.05）.The postoperative serum IL-2 was significantly reduced,and the serum IL-2 levels of postoperative 24h,36h,72h of the observation group were significantly higher than those of the control group （t=3.926,4.867,3.019,all P〈0.05）.There was no significant difference in serum IL-4 level between the two groups （t=0.416,P〉0.05）.Postoperative serum IL-4 level was significantly reduced,and the serum IL-4 level of postoperative 24h,36h,72h of the observation group were significantly higher than those of the control group （t=4.012,4.114,3.726,all P〈0.05）.Conclusion Laparoscopic distal subtotal gastrectomy for advanced gastric cancer patients has less trauma,less immunosuppression,it is conducive to postoperative recovery.