腹腔镜与开腹胃癌根治术对患者术后免疫功能的影响

Effect of laparoscopic and open radical gastrectomy on the postoperative immune function

目的探讨腹腔镜与开腹胃癌根治术对患者术后免疫功能的影响。方法回顾性分析2017年8月至2019年8月期间在商洛市中心医院胃肠外科接受根治术治疗的96例进展期胃癌患者的临床资料,根据手术方式分组,其中50例接受腹腔镜胃癌根治术者纳入观察组,余46例接受开腹胃癌根治术者纳入对照组。比较两组患者的围手术期临床指标,以及术前,术后1 d、7 d及14 d的血清T淋巴细胞亚群水平(CD3+、CD4+、CD8+、CD4+/CD8+)。结果两组患者的手术时间及淋巴结清扫数目比较差异均无统计学意义(P>0.05);观察组患者的术中出血量为(104.44±26.48)mL,明显少于对照组的(165.23±37.35)mL,术后排气时间及术后住院时间分别为(20.12±3.72)h和(11.47±2.34)d,均明显短于对照组的(26.24±4.29)h和(14.84±3.18)d,差异均具有统计学意义(P<0.05);观察组患者术后并发症发生率为6.00%,明显低于对照组的17.39%,差异具有统计学意义(P<0.05);术后1 d,两组患者的血清CD3+、CD4+、CD4+/CD8+与术前比较均明显降低,且对照组降低更加明显,差异均具有统计学意义(P<0.05);术后7 d,与术前比较,对照组患者的血清CD3+、CD4+、CD4+/CD8+仍明显降低,差异具有统计学意义(P<0.05),而观察组患者的血清CD3+、CD4+、CD4+/CD8+比较差异均无统计学意义(P>0.05);术后14 d,两组患者血CD3+、CD4+、CD4+/CD8+与术前比较差异均无统计学意义(P>0.05)。结论腹腔镜胃癌根治术治疗胃癌与开腹手术比较微创优势明显,其不仅能减少术中出血量,降低手术对患者机体细胞免疫功能的影响,而且能降低术后并发症的发生率。

Objective To investigate the effect of laparoscopic and open radical gastrectomy on the postoperative immune function of patients with gastric cancer.Methods The clinical data of 96 patients with advanced gastric cancer who underwent radical surgery in Gastrointestinal Surgery,Shangluo Central Hospital from August 2017 to August 2019 were analyzed retrospectively.According to the different operation methods,50 patients who received laparoscopic gastric cancer radical surgery were included in the observation group,and 46 patients who received open radical gastrectomy were included in the control group.The perioperative clinical indexes,and the serum T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)of 1 d,7 d and 14 d before and after operation were compared between the two groups.Results There was no significant difference between the two groups in operation time and lymph node number(P>0.05).The amount of bleeding in the observation group was(104.44±26.48)mL,which was significantly less than(165.23±37.35)mL in the control group,and the postoperative exhaust time and postoperative hospitalization time were(20.12±3.72)h and(11.47±2.34)d,respectively,which were significantly shorter than(26.24±4.29)h and(14.84±3.18)d in the control group(P<0.05).The incidence of postoperative complications in the observation group was 6.00%,which was significantly lower than 17.39%in the control group(P<0.05).Compared with those before operation,the serum CD3+,CD4+,CD4+/CD8+between the two groups decreased significantly at 1 d postoperatively,and the control group decreased more significantly(P<0.05).Compared with those before operation,the serum CD3+,CD4+,CD4+/CD8+of the control group decreased significantly at 7 d postoperatively(P<0.05).There was no significant difference in serum CD3+,CD4+,CD4+/CD8+in the observation group(P>0.05).Compared with those before operation,there was no significant difference in blood CD3,CD4,CD4/CD8 between the two groups at 14 d postoperatively(P>0.05).Conclusion Laparoscopic radical gastrectomy is more effective than open surgery in gastric cancer.It can reduce the amount of intraoperative bleeding,reduce the effect of surgery on the cellular immune function of patients,and also reduce the incidence of postoperative complications.