腹腔镜胃癌根治术对老年胃癌患者免疫功能及预后的影响

Effect of laparoscopic radical gastrectomy on immune function and prognosis in elderly patients with gastric cancer

目的 探讨腹腔镜胃癌根治术对老年胃癌患者免疫功能及预后的影响。方法 依据手术方式的不同将80例老年胃癌患者分为开腹组和腹腔镜组,每组40例,开腹组患者给予开腹胃癌根治术,腹腔镜组患者给予腹腔镜胃癌根治术。比较两组患者围手术期指标、免疫功能指标、血清肿瘤标志物[癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原125(CA125)]及预后情况。结果 腹腔镜组患者术中出血量明显少于开腹组,半流质饮食时间、下床活动时间、住院时间均明显短于开腹组,差异均有统计学意义(P﹤0.01)。手术后,两组患者CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均低于本组手术前,腹腔镜组患者CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均高于开腹组,差异均有统计学意义(P﹤0.05)。手术后,两组患者CEA、CYFRA21-1、CA125水平均低于本组手术前,且腹腔镜组患者CEA、CYFRA21-1、CA125水平均低于开腹组,差异均有统计学意义(P﹤0.05)。术后2年,腹腔镜组患者的复发率和死亡率均低于开腹组,差异均有统计学意义(P﹤0.05)。结论 腹腔镜胃癌根治术治疗老年胃癌患者具有创伤小、恢复快的优点,可降低对患者免疫功能的影响,改善预后。

Objective To explore the effect of laparoscopic radical gastrectomy on immune function and prognosis in elderly patients with gastric cancer. Method A total of 80 elderly patients with gastric cancer were divided into laparotomy group(n=40, received open laparotomy) and laparoscopic group(n=40, received laparoscopic radical gastrectomy) according to different surgical methods. The perioperative indexes, immune function indexes, serum tumor markers [carcinoembryonic antigen(CEA), cyto-keratin 19 fragment antigen 21-1(CYFRA21-1), carbohydrate antigen 125(CA125)], and prognosis were compared between the two groups. Result The amount of intraoperative bleeding in the laparoscopic group was significantly less than that in the laparotomy group, and the semi-fluid diet time, time of getting out of bed activity and hospitalization time were significantly shorter than those in the laparotomy group, the differences were statistically significant(P<0.01). After the operation, the levels of CD3^(+), CD4^(+)and CD4^(+)/CD8^(+)in the two groups were lower than those before the operation, and the levels of CD3^(+), CD4^(+)and CD4^(+)/CD8^(+)in the laparoscopic group were higher than those in the laparotomy group, the differences were statistically significant(P<0.05). After surgery, the levels of CEA, CYFRA21-1 and CA125 in the two groups were lower than those before surgery, and the levels of CEA, CYFRA21-1 and CA125 in the laparoscopic group were lower than those in the laparotomy group, the differences were statistically significant(P<0.05). Two years after operation, the recurrence rate and mortality rate of patients in the laparoscopic group were lower than those in the laparotomy group, and the differences were statistically significant(P<0.05). Conclusion Laparoscopic radical gastrectomy for elderly patients with gastric cancer has the advantages of less trauma and faster recovery, which can reduce the effect on immunity and improve prognosis.