加速康复外科理念对胃癌根治术后患者免疫功能影响的研究

Effect of fast track surgery on immune function afterradical operation for patients with gastric cancer

目的探讨在行胃癌根治术的患者中进行加速康复外科(FTS)对患者术后免疫功能影响。方法 2014年1月~2016年1月,于启东市人民医院普通外科行胃癌根治术+D2淋巴结清扫术及胃肠吻合术的患者120例,随机分为FST传统开腹组和传统开腹组。比较两组患者术后1,3d,C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(CD4+、CD8+)水平。结果两组患者术前各指标差异均无统计学意义(P>0.05)。术后1,3d,FST传统开腹组的CRP及IL-6水平与传统开腹组比较,差异有统计学意义;FST传统开腹组在术后1,3天的CRP及IL-6均低于传统开腹组,差异有统计学意义(P<0.05);FST传统开腹组术后1,3d IgM水平较传统开腹组高,两者差异有统计学意义(P<0.05),两组患者术后IgG、IgA差异无显著性;FST传统开腹组术后1,3天的CD4+、CD8+T细胞较传统开腹组高,两者差异有统计学意义(P<0.05)。结论应用FTS理念指导胃癌根治术的围手术期处理,可以使胃癌根治术患者术后的炎症反应出现下降,患者术后的细胞免疫功能得到有效的保护,加速患者的术后康复,可能使患者的预后得到一定的改善。

Objective To investigate the effect of fast track Surgery （FTS） on immune function in patients with gastric cancer after radical operation. Methods 120 patients with gastric cancer,who have be operated for gastric cancer radical ＋D2 lymph node dissection and gastrointestinal anastomosis,from January 2014 to January 2016,in general surgery department of Qidong Peoples＇ Hospital,were randomly divided into FST traditional laparotomy group and laparotomy group.After 1,3d of the operation,C reactive protein （CRP）,interleukin 6 （IL-6）,immunoglobulin （IgA,IgG,IgM） and T cell subsets （CD4＋,CD8＋） were compared between the two groups. Results There was no significant difference between the two groups before operation （P 〉 0.05）.Postoperative 1,3d,the levels of CRP and （IL-6） in the FST traditional laparotomy group were different from those in the traditional laparotomy group.Tn the FST traditional laparotomy group,the postoperative 1D,3D,CRP and IL-6 were lower than the traditional laparotomy group,the difference was significant.In the FST traditional laparotomy group,lD,3D after operation,IgM levels were higher than the traditional laparotomy group,there were significant differences between the two groups,and there was no significant difference in IgG and IgA between the two groups after operation.In the FST traditional laparotomy group,1,3D after operation,CD4＋ and CD8＋T cells were higher than the traditional laparotomy group,and there was significant difference between the two groups. Conclusion FTS philosophy to guide gastric cancer radical resection of perioperative treatment can reduce gastric cancer postoperative inflammatory reaction,protect the body＇s cellular immune function,and accelerate postoperative rehabilitation.h may play a positive role on the rehabilitation and prognosis of patientsafter operation