腹腔镜手术对老年胃癌患者术后免疫功能、感染情况及预后的影响

Effect of laparoscopic surgery on post surgery immune function,infection and prognosis in elderly patients with gastric cancer

[目的]分析并比较腹腔镜手术与传统开腹手术对我院老年胃癌患者术后免疫功能、感染情况及预后的影响。[方法]收集行胃癌根治术的老年胃癌患者120例,随机分为对照组与观察组,每组各60例。对照组患者行传统开腹手术;观察组患者行腹腔镜手术。检测2组老年患者术后CD3^+、CD4^+、CD8^+、CD4^+/CD8^+水平,分析2组患者术后感染情况及危险因素;比较2组患者术后并发症发生率、复发率及病死率。[结果]手术1周后,观察组患者T淋巴细胞水平较术前无明显变化,对照组老年患者CD3^+、CD4^+、CD4^+/CD8^+水平与术前比较显著降低(P<0.05)。观察组患者术后医院感染发生率、随访1年后并发症发生率、复发率及病死率均明显低于对照组患者<0.05)。年龄、吸烟史、发热时间、手术类型及抗菌药物使用时间,均与术后是否发生医院感染有密切关系(P<0.05)。[结论]腹腔镜手术对老年胃癌患者术后免疫功能水平影响较开腹手术小,且预后较好。高龄、吸烟史、发热时间过长、手术类型及使用抗菌药物时间过长,均会增加老年患者术后医院感染的风险,临床治疗时应提高对上述因素的重视及干预。

[Objective]To analyze and compare the effects of laparoscopic surgery and traditional open surgery on post surgery immune function,infection and prognosis in elderly patients with gastric cancer.[Methods]The totals of 120 elderly patients with gastric cancer who underwent radical gastrectomy in our hospital from February 2016 to February 2018 were randomly divided into control group and observation group,60 cases in each group.Patients in the control group underwent traditional laparotomy,while patients in the observation group underwent laparoscopic surgery.The levels of CD3^+,CD4^+,CD8^+,CD4^+/CD8^+ were detected in the two groups after the operation,and the infection and risk factors were analyzed.The incidence of complications,recurrence rate and mortality were compared between the two groups.[Results]One week after operation,there was no significant change in the levels of T lymphocyte of in the observation group.The levels of CD3^+,CD4^+,CD4^+/CD8^+ in the control group were significantly lower than those before operation(P<0.05).The incidence of nosocomial infection,complications,recurrence and mortality in the observation group were significantly lower than those in the control group(P<0.05).Age,smoking history,fever time,type of operation and time of antibiotics use were closely related to the occurrence of nosocomial infection after operation(P<0.05).[Conclusion]Laparoscopic surgery has less influence on the post surgery immune function in elderly patients with gastric cancer than traditional surgery,and the prognosis is better.Older age,smoking history,fever,type of operation and long time use of antibiotics all increase the risk of nosocomial infection in elderly patients.More attention and intervention should be paid to these factors in clinical treatment.