快速康复外科对腹腔镜远端胃癌根治术患者炎症反应和免疫功能的影响

Effect of Fast-track Rehabilitation Surgery on Inflammatory Response and Immune Function in Patients Undergoing Laparoscopic Distal Gastrectomy

目的探讨快速康复外科(FTS)对腹腔镜远端胃癌根治术患者炎症反应和免疫功能的影响。方法 244例腹腔镜远端胃癌根治术患者按围手术期处理方法不同分为快速康复外科(FTS)组126例和传统组118例,对两组患者术前和术后炎症指标、免疫指标和术后并发症进行比较。结果术后第3、7天,FTS组患者外周血淋巴细胞亚群CD3+、CD4+、CD4+/CD8+水平显著高于传统组[CD3+:(58.33±5.17)%比(51.78±5.40)%、(62.56±6.64)%比(55.58±7.16)%,P<0.05;CD4+:(26.79±3.03)%比(23.34±2.63)%、(29.01±3.83)%比(25.16±2.97)%,P<0.05;CD4+/CD8+:(1.27±0.12)%比(1.04±0.17)%、(1.49±0.24)%比(1.20±0.22),P<0.05];术后第3、7天,FTS组患者外周血IgA、IgM、IgG水平显著高于传统组[IgA:(1.73±0.18)g/L比(1.53±0.20)g/L、(1.87±0.16)g/L比(1.62±0.23)g/L,P<0.05;IgM:(0.94±0.16)g/L比(0.70±0.27)g/L、(1.30±0.19)g/L比(1.02±0.21)g/L,P<0.05;IgG:(10.20±1.44)g/L比(8.22±1.48)g/L、(12.58±1.29)g/L比(10.13±1.50)g/L,P<0.05];术后第1、3、7天,FTS组患者外周血IL-6、CRP、TNF-α水平显著低于传统组[CRP:(59.41±10.72)mg/L比(72.91±8.78)mg/L、(29.86±8.67)mg/L比(39.31±8.65)、(9.73±4.05)mg/L比(16.37±5.41)mg/L,P均<0.05;IL-6:(59.19±9.21)ng/L比(79.87±12.01)ng/L、(19.14±8.59)ng/L比(27.69±6.69)ng/L、(10.21±4.64)ng/L比(15.56±4.72)ng/L,P均<0.05;TNF-α:(150.98±10.28)ng/L比(165.24±16.08)ng/L、(125.06±15.63)ng/L比(147.56±17.99)ng/L、(107.96±15.98)ng/L比(123.44±13.45)ng/L,P均<0.05];FTS组术后并发症发生率明显低于传统组,差异有统计学意义(P<0.05)。结论快速康复外科能有效降低胃癌根治术患者炎症反应程度和术后并发症发生率,对机体免疫功能影响更小。

Objective To investigate the effect of fast-track rehabilitation surgery(FTS) on inflammatory response and immune function in patients undergoing laparoscopic distal gastrectomy for gastric cancer. Methods A total of 244 patients of laparoscopic radical gastrectomy for distal gastric cancer were divided into FTS group(126 cases) and traditional group(118 cases) according to different perioperative management methods. The inflammation index, immune index and complications before and after operation were compared between the two groups. Results On the 3rd and 7th day after operation, the levels of CD3+, CD4+, CD4+/CD8+ in peripheral blood lymphocyte subsets and the levels of IgA, IgM and IgG of FTS group were significantly higher than those of traditional group. CD3+:(58.33±5.17) vs (51.78±5.40)%,(62.56±6.64) vs (55.58±7.16)%;CD4+:(26.79±3.03) vs (23.34±2.63)%,(29.01±3.83) vs (25.16±2.97)%;CD4+/CD8+:(1.27±0.12) vs (1.04±0.17)%,(1.49±0.24) vs (1.20±0.22)%;IgA:(1.73±0.18) vs (1.53±0.20)g/L,(1.87±0.16) vs (1.62±0.23)g/L;IgM:(0.94±0.16) vs (0.70±0.27)g/L,(1.30±0.19) vs (1.02±0.21)g/L;IgG:(10.20±1.44) vs (8.22±1.48)g/L,(12.58±1.29) vs (10.13±1.50)g/L. All P<0.05. On the 1st, 3rd and 7th day after operation, the levels of CRP, IL-6 and TNF-α in peripheral blood of FTS group were significantly lower than those of traditional group. CRP:(59.41±10.72) vs (72.91±8.78)mg/L,(29.86±8.67) vs (39.31±8.65)mg/L,(9.73±4.05) vs (16.37±5.41)mg/L;IL-6:(59.19±9.21) vs (79.87±12.01)ng/L,(19.14±8.59) vs (27.69±6.69)ng/L,(10.21±4.64) vs (15.56±4.72)ng/L;TNF-α:(150.98±10.28) vs (165.24±16.08)ng/L,(125.06±15.63) vs (147.56±17.99)ng/L,(107.96±15.98) vs (123.44±13.45)ng/L. All P<0.05. The incidence of postoperative complications in FTS group was significantly lower than that in traditional group, and the difference was statistically significant(P<0.05). Conclusion Fast-track rehabilitation surgery can effectively reduce the degree of inflammation and the incidence of complications in patients with radical gastrectomy, and has less impact on the immune function of the body.