经腹贲门癌根治术对贲门癌患者应激及免疫功能的影响

Effect of radical gastrectomy for stress and immune function in patients with cardiac cancer

目的:探讨经腹与经胸两种手术方式对贲门癌患者围术期应激及免疫功能的影响。方法:收集2016年5月~2017年10月我院收治的贲门癌患者60例,依据手术方式的不同分为经胸组和经腹组,各30例。比较两组患者术前及术后7d后炎症因子水平、T淋巴细胞亚群、NK细胞、免疫球蛋白及氧化应激指标的变化。结果:两组患者术前炎症因子水平、T淋巴细胞亚群、NK细胞、免疫球蛋白及氧化应激指标比较无显著差异(P>0.05)。术后7d,两组患者皮质醇(cortisol,COR)和C反应蛋白(C-reactive protein,CRP)水平均有所上升(P<0.05),但经腹组COR和CRP均低于经胸组(P<0.05)。两组患者术后CD4^+、CD4^+/CD8^+水平显著降低,CD8^+和NK水平显著升高,且经腹组CD4^+和CD4^+/CD8^+均高于经胸组;CD8^+和NK细胞数低于经胸组(P<0.05)。两组患者术后IgA、IgG和IgM水平显著降低,但经腹组IgA、IgG和IgM均高于经胸组。两组患者术后丙二醛(malondialdehyde,MDA)水平均有所上升(P<0.05),超氧化物歧化酶(superoxide dismutase,SOD)有所降低。但经腹组MDA低于经胸组,SOD高于经胸组(P<0.05)。结论:经腹贲门癌根治术可减轻贲门癌患者术后炎症应激和氧化应激,保护免疫功能。

Objective： To investigate the effects of abdominal and transthoracic surgery on perioperative stress and immune function in patients with cardiac cancer. Methods： A total of 60 patients with cardiac cancer treated in our hospital from May 2016 to October 2017 were collected. According to the different surgical methods, they were divided into the transthoracic group and the abdominal group, with 30 cases in each group. The changes of inflammatory factors, T-lymphocyte subsets, NK cells, immune globulin, and oxidative stress parameters were compared between the two groups before and 7 days after surgery. Result： There were no significant differences in preoperative inflammatory factors, T lymphocyte subsets, NK cells, immunoglobulins, and oxidative stress between the two groups （ P 〉0.05）. At 7 days after surgery, COR and CRP levels increased in both groups （ P 〈0.05）, but COR and CRP levels in abdominal group were lower than those in transthoracic group （ P 〈 0.05）. The levels of CD4 ＋,CD4 ＋/CD8 ＋and CD8 ＋ and NK were significantly increased in both groups after operation, and CD4 ＋ and CD4 ＋/CD8 ＋ were higher than those in the transabdominal group. While the number of CD8 ＋ and NK cells in the group was lower than those in the transthoracic group （ P 〈0.05）. The levels of IgA, IgG, and IgM were significantly reduced in both groups after operation, and IgA, IgG, and IgM were higher than those in the transabdominal group （ P 〈0.05）. MDA levels in both groups were increased, while SOD levels in both groups were decreased （ P 〈0.05）. However, the MDA in the abdominal group was lower than that in the transthoracic group, and the SOD was higher than that in the transthoracic group （ P 〈0.05）. Conclusion： The radical gastrectomy can reduce inflammatory stress and oxidative stress in patients with cardiac cancer and protect immune function.