腹腔镜辅助胃癌根治术和常规开腹胃癌根治术对患者免疫指标及微转移的影响
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摘要
目的探讨腹腔镜辅助胃癌根治术和常规开腹胃癌根治术对患者免疫指标及微转移的影响。方法回顾性分析70例胃癌患者的临床资料,其中,行腹腔镜辅助胃癌根治术的35例患者为观察组,行常规开腹胃癌根治术的35例患者为对照组。比较两组患者手术前后不同时间点外周血免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、补体C3、补体C4水平的变化情况,以及腹腔引流液中白细胞介素-10(IL-10)水平和腹腔冲洗液中癌胚抗原(CEA)、多巴脱羧酶(DDC)水平的变化情况。结果术后即刻,两组患者外周血中的IgG、IgA、IgM、C3及C4水平均降至最低,术后1天、3天均开始呈现逐渐升高的趋势,至术后7天均接近术前水平。两组患者的C3水平在组间、不同时点间、组间·不同时间点比较,差异均有统计学意义(P﹤0.05)。两组患者不同时间点的IgG、IgA、IgM、C4水平比较,差异均有统计学意义(P﹤0.05)。术后1～3天,两组患者腹腔引流液中的IL-10水平均高于术后即刻,且至术后1天达最高水平,术后2天及3天逐渐降低。术后,两组患者腹腔引流液中的IL-10水平在组间、不同时间点、组间·不同时间点比较,差异均有统计学意义(P﹤0.05)。观察组和对照组患者手术结束时腹腔冲洗液中的CEA、DDC水平均高于本组手术开始时(P﹤0.05)。手术结束时,观察组患者的CEA、DDC水平均低于对照组患者(P﹤0.05)。结论腹腔镜辅助胃癌根治术对患者免疫功能的影响较小,微转移相关指标较低,较常规开腹胃癌根治术具有优势。
Objective To compare the effects of laparoscopic assisted radical gastrectomy and conventional open radical gastrectomy on immune parameters and micrometastasis in patients with gastric cancer.Method The clinical data of 70 patients with gastric cancer analyzed retrospectively,including 35 cases of laparoscopic assisted radical gastrectomy for gastric cancer as the observation group,35 cases conventional open radical gastrectomy for gastric cancer as control group.The changes of immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM),C3 and C4 in peripheral blood of patients before and after surgery at different time points were compared between the two groups,the postoperative changes of interleukin-10(IL-10) level in abdominal drainage fluid and carcinoembryonic antigen(CEA)and dopadecarboxylase(DDC) levels in peritoneal lavage fluid between the two groups were also compared.Result The levels of IgG,IgA,IgM,C3 and C4 were decreased to the lowest level immediately after operation in both groups,and gradually increased after 1 and 3 days,which approached the preoperative level at the 7 thday after operation.There were significant differences in the C3 level between the two groups,between different time points and between groups at the same time points(P<0.05).The differences in IgG,IgA,IgM and C4 levels between the two groups at different time points were all statistically significant(P<0.05).The levels of IL-10 in the peritoneal drainage fluid in both groups were significantly increased immediately after operation,reaching the highest level at 1 d after operation,and decreased gradually after 2 d and 3 d.There were significant differences in peritoneal drainage fluid IL-10 level between the two groups after operation,between different time points and between groups at the same time point(P<0.05).The CEA and DDC levels in peritoneal lavage fluid between the patients of observation group and control group after operation were significantly higher than those at the beginning of operation(P<0.05).At the end of surgery,the CEA and DDC levels in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Laparoscopic assistedradical gastrectomy has less effect on the immune function of patients,and the relative indexes of micrometastasis are lower,which has advantages over laparotomy.
Objective To compare the effects of laparoscopic assisted radical gastrectomy and conventional open radical gastrectomy on immune parameters and micrometastasis in patients with gastric cancer.Method The clinical data of 70 patients with gastric cancer analyzed retrospectively,including 35 cases of laparoscopic assisted radical gastrectomy for gastric cancer as the observation group,35 cases conventional open radical gastrectomy for gastric cancer as control group.The changes of immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM),C3 and C4 in peripheral blood of patients before and after surgery at different time points were compared between the two groups,the postoperative changes of interleukin-10(IL-10) level in abdominal drainage fluid and carcinoembryonic antigen(CEA)and dopadecarboxylase(DDC) levels in peritoneal lavage fluid between the two groups were also compared.Result The levels of IgG,IgA,IgM,C3 and C4 were decreased to the lowest level immediately after operation in both groups,and gradually increased after 1 and 3 days,which approached the preoperative level at the 7 thday after operation.There were significant differences in the C3 level between the two groups,between different time points and between groups at the same time points(P<0.05).The differences in IgG,IgA,IgM and C4 levels between the two groups at different time points were all statistically significant(P<0.05).The levels of IL-10 in the peritoneal drainage fluid in both groups were significantly increased immediately after operation,reaching the highest level at 1 d after operation,and decreased gradually after 2 d and 3 d.There were significant differences in peritoneal drainage fluid IL-10 level between the two groups after operation,between different time points and between groups at the same time point(P<0.05).The CEA and DDC levels in peritoneal lavage fluid between the patients of observation group and control group after operation were significantly higher than those at the beginning of operation(P<0.05).At the end of surgery,the CEA and DDC levels in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Laparoscopic assistedradical gastrectomy has less effect on the immune function of patients,and the relative indexes of micrometastasis are lower,which has advantages over laparotomy.
引文
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[5]陈秋贤,蔡丽生,方顺勇,等.腹腔镜胃癌根治性全胃切除术后外科并发症的Clavien-Dindo分级及危险因素分析[J].中国微创外科杂志, 2017, 17(2):120-125.
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[7]徐卫国,徐华,马君俊,等.腹腔镜辅助胃癌根治术后并发症的Clavien-Dindo分级及危险因素分析[J].中华消化外科杂志, 2016, 15(3):228-233.
[8]程黎阳,谢正勇,王弘,等.腹腔镜辅助的胃癌前哨淋巴结活检[J].广东医学, 2009, 30(4):554-556.
[9]赵群,李勇,王贵英,等.腹腔镜与开腹手术行胃癌根治术效果的临床对照研究[J].中国全科医学, 2013, 16(2):210-212; 215.
[10] Sakakura C, Takemura M, Hagiwara A, et al. Overexpression of dopa decarboxylase in peritoneal dissemination of gastric cancer and its potential as a novel marker for the detection of peritoneal micrometastases with real-time RTPCR[J]. Br J Cancer, 2004, 90(3):665-671.
[2]李晓峰,杨生虎,韩云,等.腹腔镜下D2根治术治疗局部进展期远端胃癌30例效果观察[J].山东医药, 2016, 56(13):54-56.
[3]王红岩,赵晓丹,李国胜,等.腹腔镜辅助与开腹胃癌D2根治术治疗局部进展期远端胃癌的安全性及近期疗效Meta分析[J].中国医科大学学报, 2015, 44(3):252-258.
[4]胡小苗,向进见.腹腔镜辅助远端胃癌D2根治术的疗效及安全性探讨[J].中国内镜杂志, 2017, 23(4):76-80.
[5]陈秋贤,蔡丽生,方顺勇,等.腹腔镜胃癌根治性全胃切除术后外科并发症的Clavien-Dindo分级及危险因素分析[J].中国微创外科杂志, 2017, 17(2):120-125.
[6]魏登文,刘宏斌,李洪涛,等.腹腔镜进展期胃癌根治术对患者免疫功能的影响[J].海南医学, 2014, 25(20):2989-2992.
[7]徐卫国,徐华,马君俊,等.腹腔镜辅助胃癌根治术后并发症的Clavien-Dindo分级及危险因素分析[J].中华消化外科杂志, 2016, 15(3):228-233.
[8]程黎阳,谢正勇,王弘,等.腹腔镜辅助的胃癌前哨淋巴结活检[J].广东医学, 2009, 30(4):554-556.
[9]赵群,李勇,王贵英,等.腹腔镜与开腹手术行胃癌根治术效果的临床对照研究[J].中国全科医学, 2013, 16(2):210-212; 215.
[10] Sakakura C, Takemura M, Hagiwara A, et al. Overexpression of dopa decarboxylase in peritoneal dissemination of gastric cancer and its potential as a novel marker for the detection of peritoneal micrometastases with real-time RTPCR[J]. Br J Cancer, 2004, 90(3):665-671.