快速康复外科理念应用对宫颈癌围手术期患者免疫功能的影响

Impact of the Application of Fast Track Surgery Concept during Perioperative Period on Immunity Function in Patients with Cervical Cancer

目的:观察应用快速康复外科理念对宫颈癌围手术期干预的效果,及其对机体体液和细胞免疫的影响。方法:选择2017年1月至2019年12月于我院手术且病理确诊为宫颈癌患者92例作为研究对象,按照随机数字表法将患者分为观察组和对照组,每组各46例。对照组患者围手术期予以传统康复方案,观察组患者在对照组的基础上予以快速康复外科理念干预。比较两组患者术后临床指标和并发症发生率,比较两组患者术后1 d和术后7 d血清免疫球蛋白(Ig)A、IgG、IgM、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、干扰素(IFN)-γ、肿瘤坏死因子(TNF)-α、白介素(IL)-6和IL-10水平的变化。结果:观察组患者的术后首次下床时间、首次进食时间、首次排气时间、首次排便时间和住院时间均短于对照组(P<0.01)。观察组患者术后并发症发生率(8.70%)低于对照组(28.26%)(χ^(2)=4.618,P<0.05)。两组患者术前和术后1 d血清IgA、IgG、IgM、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IFN-γ、TNF-α、IL-6和IL-10水平差异均无统计学意义(P>0.05);术后1 d和术后7 d,两组患者血清IgA、IgG、IgM、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IL-6和IL-10水平较术前均降低(P<0.01),血清IFN-γ和TNF-α水平较术前均升高(P<0.01);术后7d,两组患者IgA、IgG、IgM、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IL-6和IL-10水平较术后1 d均升高(P<0.01),且观察组患者升高幅度较对照组更为明显(P<0.01);术后7 d,两组患者血清IFN-γ和TNF-α水平较术后1 d均降低(P<0.01),且观察组患者降低幅度均较对照组更为明显(P<0.01)。结论:应用快速康复外科理念对宫颈癌围手术期干预效果显著,可促进机体康复,降低术后并发症,其机理可能与提高机体的体液和细胞免疫有关。

Objective:To observe the efficacy of the application of fast track surgery concept during perioperative period in patients with cervical cancer and its impact on humoral immunity and cellular immunity.Methods:92 patients with cervical cancer diagnosed and treated in our hospital from January 2017 to December 2019 were divided into the observation group and the control group according to random number method,with 46 patients in each group.The patients of the control group were treated with traditonal rehabilitation plan during the perioperative period,and the patients of the observation group were treated with the fast track surgery concept on the basis of the control group.The postoperative clinical indicators and complications were compared between two groups,and the levels of immunoglobulin(Ig)A,IgG,IgM,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),interferon(IFN)-γ,tumor necrosis factor(TNF)-ɑ,interleukin(IL)-6 and IL-10 at 1 d and 7 d after surgery were also compared between the two groups.Results:The postoperative first out-of-bed time,first feeding time,first exhaust time,first defecation time and hospital stay time in the observation group were shorter than those in the control group(P<0.01).The incidence rate of complication in the observation group was 8.70%,which was lower than 28.26%in the control group(χ^(2)=4.618,P<0.05).There was no significant difference in serum IgA,IgG,IgM,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IFN-γ,TNF-α,IL-6 and IL-10 levels between two groups before surgery and at 1 d after surgery(P>0.05).At 1 d after surgery and 7 d after surgery,the serum IgA,IgG,IgM,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IL-6 and IL-10 levels in two groups were lower than those before surgery(P<0.01),and the serum IFN-γand TNF-ɑlevels in two groups were higher than before surgery(P<0.01).At 7 d after surgery,the serum levels of IgA,IgG,IgM,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IL-6 and IL-10 were higher than those at 1 d after surgery(P<0.01),while the increase level in the observation group was more obvious than that in the control group(P<0.01).At 7 d after surgery,the serum levels of IFN-γand TNF-ɑin two groups were lower than those at 1 d after surgery(P<0.01),while the decrease level in the observation group was more obvious than that in the control group(P<0.01).Conclusion:The application of fast track surgery concept has significant efficacy on perioperative intervention of cervical cancer,which can promote rapid recovery of the body and reduce postoperative complications.Its mechanism may be related to the improvement of the body′s humoral and cellular immunity.