快速康复外科在结直肠肿瘤围手术期中的应用

Application of fast track surgery in the perioperative period of colorectal cancer

目的探讨腹腔镜结直肠癌根治术联合快速康复外科技术对患者术后免疫功能和炎症反应的影响。方法回顾性分析湖北省肿瘤医院150例结直肠癌患者的临床资料,其中行腹腔镜联合快速康复外科治疗60例(实验组),传统开腹手术治疗90例(对照组)。比较分析两组患者术前和术后l d、4 d、7 d静脉血C反应蛋白(C reactive protein,CRP)、CD4+T细胞(%)、CD8+T细胞(%)、CD4+/CD8+水平。结果所有患者手术均顺利完成,术后恢复良好。两组患者术后CRP较术前均有升高,且对照组较实验组升高程度更大(P<0.01);CD4+T细胞(%)、CD8+T细胞(%)、CD4+/CD8+水平术后1 d均较术前下降,对照组下降程度高于实验组(P<0.01),且对照组在术后4 d、7 d仍处于较低状态。结论与常规开腹手术相比,腹腔镜手术联合快速康复外科治疗对患者免疫功能的影响更小,患者恢复更快。

Objective To investigate the laparoscopic colorectal cancer radical resectioncombined with fast track surgery effect on immune function and inflammatory responses. Methods Clinicalretrospective data were analyzed for 150 cases of colorectal cancer patients, of who laparoscopy combinedwith rapid rehabilitation surgical treatment (experimental group) and raditional open surgery (control group)were underwent in 60 cases and 90 cases, respectively. Comparative analysis of C-reactive protein, CD4+Tcells (%), CD8+T cells (%), CD4+/CD8+ level between two groups of patients before and after surgery, in theday of 1,4,7. Results All patients were successfully completed surgery, postoperative recovery was good.Two groups of patients with postoperative CRP were higher than that before operation. Compared with theexperimental group, the control group increased more (P < 0.01); 1 day after operation, CD4+T cells (%),CD8+T cells (%), CD4+/CD8+ level were decreased, control group decreased obviously in the experimentalgroup and the control group (P < 0.01), after day 4,7 the level was still low. Conclusion Compared withconventional open surgery, laparoscopic surgery combined with rapid rehabilitation surgery has less influenceon the immune function of patients, and the patients recover more quickly.