芪参复肠方保留灌肠对腹腔镜直肠癌根治术后细胞免疫功能及肠黏膜损伤的影响

Effects of Qishen Fuchang prescription retention enema on cellular immune function and intestinal mucosal damage after laparoscopic radical resection of rectal cancer

[目的]探讨中药芪参复肠方保留灌肠对腹腔镜直肠癌根治术后细胞免疫功能、肠黏膜损伤的影响。[方法]选择秦皇岛市海港医院2017年6月~2020年1月收治的84例直肠癌患者,按照随机数字表法分为2组,每组42例,2组均接受腹腔镜直肠癌根治术,对照组术后维持水、电解质酸碱平衡,并给予营养支持、抗生素等常规治疗及其他对症处理。中药组在对照组治疗基础上,于术后24 h应用中药芪参复肠方保留灌肠,2次/d,连续治疗7 d。比较2组术后肠鸣音恢复时间、首次排气时间、首次排便时间和腹胀发生率,并比较2组术后第1、4、7天血清胃动素、胃泌素水平;比较2组术后第1、7天外周血CD3^+、CD4^+、CD8^+、NK细胞含量及CD4^+/CD8^+,血清肠型脂肪酸结合蛋白、二胺氧化酶水平。[结果]中药组肠鸣音恢复时间、首次排气时间和首次排便时间均短于对照组(P<0.01),腹胀发生率低于对照组(P<0.05);术后第4天,中药组血清胃动素、胃泌素水平均高于对照组(P<0.01);术后第7天中药组外周血CD3^+、CD4^+、NK细胞含量及CD4^+/CD8^+高于对照组(P<0.01),血清肠型脂肪酸结合蛋白、二胺氧化酶水平均低于对照组,均差异有统计学意义(P<0.01)。[结论]腹腔镜直肠癌根治术后应用芪参复肠方保留灌肠可增强机体细胞免疫功能,减轻肠黏膜损伤,在早期提高胃肠激素水平,促进胃肠功能的恢复。

[Objective]To investigate the effect of traditional Chinese medicine(TCM)Qishen Fuchang prescription retention enema on cellular immune function and intestinal mucosal damage after laparoscopic radical resection of rectal cancer.[Methods]Eighty-four patients with rectal cancer addmitted to Qinhuangdao Harbor Hospital from June,2017 to January,2020 were divided into two groups according to the number random table method,with 42 cases in each group,both groups received laparoscopic radical resection of rectal cancer,in the control group,the acid-base balance of water and electrolyte was maintained,and routine treatment such as nutrition support,antibiotics and other symptomatic treatment were given.On the basis of the treatment in the control group,The TCM group received retention enema with Qishen Fuchang prescription in 24 hours after the operation,twice a day for 7 days.Postoperative bowel sounds recovery time,first exhaust time,first defecation time and the incidence of abdominal distension were compared between the two groups,and the levels of serum motilin(MTL)and gastrin(GAS)were compared between the two groups in the1 st day,4 th day and 7 th day.The contents of CD3^+,CD4^+,CD8^+,NK cells and CD4^+/CD8^+values in peripheral blood of the two groups in the 1 st day and the 7 th day after surgery were compared,and the levels of serum intestinal fatty acid binding protein and diamine oxidase in the two groups in the 1 st day and the 7 th day after surgery were compared.[Results]The recovery time,the first exhaust time and the first defecation time of the TCM group were shorter than those of the control group(P<0.01),and the incidence of abdominal distension was lower than that of the control group(P<0.05).In the fourth day after the operation,the serum MTL and GAS levels of the TCM group were higher than those of the control group(P<0.01).The levels of CD3^+,CD4^+and NK cells and CD4^+/CD8^+in peripheral blood of the two groups in the 7 th day after surgery were higher than those of the control group(P<0.01),and the serum levels of intestinal fatty acid binding protein and diamine oxidase were lower than those of the control group(P<0.01),the difference was statistically significant.[Conclusion]The retention enema of Qishen Fuchang prescription after laparoscopic radical resection of rectal cancer can enhance the body cells Immune function,reduce intestinal mucosal damage,early increase the level of gastrointestinal hormones,promote the recovery of gastrointestinal function.