超声刀对胃癌D_2根治术患者营养状况及生活质量的影响

Effect of ultrasonic scalpel on nutritional status and quality of life in patients undergoing D_2 radical gastrectomy

目的探讨超声刀对胃癌D_2根治术患者营养状况及生活质量的影响。方法选取2014年6月至2017年6月间在榆林市第一医院普外二科行胃癌D_2根治手术患者60例,依据随机数表法将患者分为观察组和对照组,每组30例。观察组患者采用超声刀手术,对照组患者则采用高频电刀手术。比较两组患者术中和术后恢复情况,以及手术前后患者营养状况(依据欧洲营养风险筛查标准进行评估)、生活质量(依据胃癌特异性量表进行评估)情况、血清糖链抗原125(CA125)、糖链抗原199(CA199)及癌坯抗原(CEA)含量和T细胞亚群变化情况。结果观察组患者的手术时间、住院时间与术后排气、进食时间分别为(169.27±20.38)分、(8.01±1.25)d、(3.17±1.05)d、(3.31±1.05)d,明显低于对照组的(217.04±30.28)分、(11.34±2.06)d、(4.97±0.97)d、(4.99±1.07)d,差异均有统计学意义(P<0.05);观察组患者手术后功能、生理、情况、家庭、附加及营养评分分别为(11.04±2.91)分、(10.66±2.01)分、(8.17±1.36)分、(7.19±1.52)分、(24.91±8.04)分、(24.30±3.29)分,均明显优于治疗前的(18.27±3.08)分、(18.49±3.52)分、(16.74±2.22)分、(17.10±3.38)分、(45.37±15.29)分、(18.15±4.26)分和对照组的(14.33±2.62)分、(13.51±1.83)分、(11.29±1.83)、(11.27±1.24)分、(30.91±5.44)分、(21.09±3.94)分,差异均有统计学意义(P<0.05);术后观察组患者的血清CA125、CEA及CA199含量分别为(39.84±12.41)U/m L、(15.41±5.08)ng/L、(31.08±10.26)U/m L,较治疗前的(55.10±18.05)U/m L、(62.94±13.06)ng/L、(72.94±19.33)U/m L和对照组的(41.27±13.25)U/m L、(25.94±4.37)ng/L、(40.25±12.49)U/m L明显降低,差异均有统计学意义(P<0.05);术后观察组患者的CD8+水平为(25.97±3.89)%,较治疗前的(57.39±5.03)%和对照组的(36.39±4.09)%明显下降,CD4+水平和CD4+/CD8+比值分别为(39.05±5.28)%、(1.54±0.38),较治疗前的(16.12±3.08)%、(0.33±0.19)和对照组的(28.74±4.70)%、(0.95±0.28)明显升高,差异均有统计学意义(P<0.05)。结论超声刀对胃癌D_2根治术患者创伤小,恢复快,可明显改善患者术后营养状况生活质量,值得临床推广应用。

Objective To investigate the effect of ultrasonic scalpel on nutritional status and quality of life in patients undergoing D2 radical gastrectomy. Methods A total of 60 patients with gastric cancer undergoing D2 radical gastrectomy in the Second Department of General Surgery, the First Hospital of Yulin were selected from June 2014 to June 2017. According to the random number table, the patients were divided into observation group and control group,with 30 cases in each group. The observation group was treated with an ultrasonic scalpel, and the control group was treated with a high frequency electric knife. The intraoperative and postoperative recovery of the two groups were compared, as well as the nutritional status of the patients before and after surgery（assessed according to European Nutritional Risk Screening Criteria）, quality of life（assessed on the basis of Specific Gastric Cancer Scales）, and serum carbohydrate antigen 125（CA125）, carbohydrate antigen 199（CA199） and cancer blank antigen（CEA） content and T cell subpopulation changes. Results The operation time, hospital stay, postoperative exhaust and eating time in the observation group were（169.27±20.38） min,（8.01±1.25） d,（3.17±1.05） d,（3.31±1.05） d, respectively, which were significantly lower than（217.04±30.28） min,（11.34±2.06） d,（4.97±0.97） d, and（4.99±1.07） d in the control group（P〈0.05）. After treatment, the functional, physiological, conditional, family, attachment, and nutritional scores in the observation group were（11.04±2.91）,（10.66±2.01）,（8.17±1.36）,（7.19±1.52）,（24.91±8.04） and（24.30±3.29）, respectively, which were significantly better than（18.27±3.08）,（18.49±3.52）,（16.74±2.22）,（17.10±3.38）,（45.37±15.29）,（18.15±4.26） before treatment,and（14.33±2.62）,（13.51±1.83）,（11.29±1.83）,（11.27±1.24）,（30.91±5.44）, and（21.09±3.94） in the control group（P〈0.05）. After treatment, the serum levels of CA125, CEA, and CA199 in the observation group were（39.84±12.41） U/m L,（15.41±5.08） ng/L,（31.08±10.26） U/m L, respectively, which were significantly lower than（55.10±18.05） U/m L,（62.94±13.06） ng/L,（72.94±19.33） U/m L before treatment and（41.27±13.25） U/m L,（25.94±4.37） ng/L,（40.25±12.49） U/m L in the control group（P〈0.05）. The CD8＋level in the observation group was（25.97±3.89）%, which was significantly lower than（57.39±5.03）% before treatment and（36.39±4.09）% in the control group. The ratio of CD4＋and CD4＋/CD8＋were（39.05±5.28）%,（1.54±0.38）, respectively, which were significantly higher than（16.12±3.08）%,（0.33±0.19） before treatment and（28.74±4.70）%,（0.95±0.28） in the control group（P〈0.05）. Conclusion Ultrasonic scalpel has advantages of less trauma and rapid recovery for patients undergoing D2 radical gastrectomy, which can significantly improve nutritional status and quality of life of patients after operation. It is worthy of clinical application.