腹腔镜胃癌根治术对进展期胃癌的应激、免疫变化及并发症的影响
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摘要
目的研究腹腔镜胃癌根治术对进展期胃癌患者应激、免疫功能及并发症发生率的影响。方法选取2014年8月至2017年2月76例进展期胃癌患者为研究对象,按随机数表法分为观察组与对照组,各38例。观察组采取腹腔镜胃癌根治术,对照组常规开腹行胃癌根治术,比较两组术前、术后1、4、7 d应激指标白细胞(WBC)、C反应蛋白(CRP)、白细胞介素(IL)-6水平及免疫功能CD4~+、CD8~+,CD4~+/CD8~+的差异,记录术后并发症发生率。选择术后1 d应激指标,绘制WBC、CRP、IL-6预测术后并发症的ROC曲线。结果两组术后1 d WBC、CRP、IL-6与术前比较均显著升高(P均<0.05);随时间推移呈降低趋势,观察组术后1、4 d WBC、CRP、IL-6均显著低于对照组(P均<0.05);术后7 d两组各应激指标比较差异无统计学意义(P均>0.05)。两组术后CD4~+、CD4~+/CD8~+呈降低趋势,CD8~+呈增高趋势,观察组术后4、7 d CD4~+、CD4~+/CD8~+显著高于对照组,CD8~+显著低于对照组(P均<0.05)。观察组术后并发症总发生率显著低于对照组(10.53%vs 31.58%,P<0.05);WBC、CRP、IL-6预测术后并发症曲线下面积分别0.876、0.761、0.718。结论与开腹手术比较,腹腔镜胃癌根治术治疗进展期胃癌,其术后应激、免疫抑制较轻,并发症风险较低。术后应激炎性指标对并发症的发生有一定预测作用,其降低可能是腹腔镜手术术后并发症发生率降低的影响因素之一。
Objective To study the influences of laparoscopic radical gastrectomy on stress,immune function and complication rate in patients with advanced gastric cancer. Methods A total of 76 patients with advanced gastric cancer were selected from August 2014 to Membery 2017 and randomly divided into observation group and control group( n = 38 each). The laparoscopic radical gastrectomy was conducted in observation group,while the open radical gastrectomy was performed in control group. The stress markers including white blood cell( WBC),C reactive protein( CRP),interleukin-6( IL-6) and changes of CD4~+,CD8~+,CD4~+/CD8~+were compared before operation and at 1-,4-and 7-day after operation between two groups. The incidence of postoperative complications was recorded. The WBC,CRP and IL-6 at 1-day after operation were used to draw ROC curve to predict postoperative complications. Results The levels of WBC,CRP and IL-6 in both two groups significantly increased 1-day after operation compared with pre-operation( all P < 0. 05),they showed a decreasing tendency over time and were significantly lower in observation group than those in control group at 1-,4-day after operation( all P < 0. 05). There was no significantdifference in stress index 7 days after operation between two groups( all P > 0. 05). The postoperative levels of CD4~+and CD4~+/CD8~+tended to decrease,and level of CD8~+tended to increase in both two groups. Compared with control group,the levels of CD4~+,CD4~+/CD8~+increased significantly,and the level of CD8~+decreased 4 days and 7 days after surgery in observation group( all P < 0. 05). The incidence of postoperative complications in observation group was significantly lower than that in control group( 10. 53% vs 31. 58%,P < 0. 05). The area under the ROC curve of WBC,CRP and IL-6 to predict postoperative complications were 0. 876,0. 761 and 0. 718 respectively. Conclusions Compared with open surgery,laparoscopic radical gastrectomy has lighter stress and immune suppression,lower risk of complications in the treatment of advanced gastric cancer. Stress indicators have certain predictive effect for postoperative complications. The decrease of the index may be one of the factors for lower incidence of complications after laparoscopic surgery.
Objective To study the influences of laparoscopic radical gastrectomy on stress,immune function and complication rate in patients with advanced gastric cancer. Methods A total of 76 patients with advanced gastric cancer were selected from August 2014 to Membery 2017 and randomly divided into observation group and control group( n = 38 each). The laparoscopic radical gastrectomy was conducted in observation group,while the open radical gastrectomy was performed in control group. The stress markers including white blood cell( WBC),C reactive protein( CRP),interleukin-6( IL-6) and changes of CD4~+,CD8~+,CD4~+/CD8~+were compared before operation and at 1-,4-and 7-day after operation between two groups. The incidence of postoperative complications was recorded. The WBC,CRP and IL-6 at 1-day after operation were used to draw ROC curve to predict postoperative complications. Results The levels of WBC,CRP and IL-6 in both two groups significantly increased 1-day after operation compared with pre-operation( all P < 0. 05),they showed a decreasing tendency over time and were significantly lower in observation group than those in control group at 1-,4-day after operation( all P < 0. 05). There was no significantdifference in stress index 7 days after operation between two groups( all P > 0. 05). The postoperative levels of CD4~+and CD4~+/CD8~+tended to decrease,and level of CD8~+tended to increase in both two groups. Compared with control group,the levels of CD4~+,CD4~+/CD8~+increased significantly,and the level of CD8~+decreased 4 days and 7 days after surgery in observation group( all P < 0. 05). The incidence of postoperative complications in observation group was significantly lower than that in control group( 10. 53% vs 31. 58%,P < 0. 05). The area under the ROC curve of WBC,CRP and IL-6 to predict postoperative complications were 0. 876,0. 761 and 0. 718 respectively. Conclusions Compared with open surgery,laparoscopic radical gastrectomy has lighter stress and immune suppression,lower risk of complications in the treatment of advanced gastric cancer. Stress indicators have certain predictive effect for postoperative complications. The decrease of the index may be one of the factors for lower incidence of complications after laparoscopic surgery.
引文
[1]杨洪霞,孙折玉,万海涛,等.局部进展期胃癌新辅助放化疗的疗效评价[J].医学研究杂志,2015,44(1):132-135.
[2]刘宏斌,韩晓鹏,朱万坤,等.腹腔镜在进展期胃癌中的应用[J].医学研究杂志,2011,40(3):48-50.
[3]孙小飞,何子锐.腹腔镜与开腹根治术对进展期胃癌患者免疫及应激水平的影响[J].海南医学院学报,2016,22(22):2721
[4]王盼,杨秀春,刘小宇,等.腹腔镜胃癌根治术治疗进展期胃癌对患者血清应激炎症因子的影响[J].医学临床研究,2016,33(9):1798-1800.
[5]钟惠,江英强,尹亚岚,等.麻醉方式对胃癌患者术后呼吸道感染及T淋巴细胞和应激水平的影响[J].中华医院感染学杂志,2017,27(3):609-612.
[6]韩闻卿,姜雅秋.应激时中枢性胰高血糖素样肽1对下丘脑-垂体-肾上腺轴作用的研究进展[J].医学综述,2016,22(19):3753-3756.
[7]杜建军,王园园,郭雄飞,等.腹腔镜手术治疗结肠癌的围术期应激反应及免疫功能观察[J].结直肠肛门外科,2015,21(6):413-417.
[8]汤雪峰,李财宝,刘岗,等.腹腔镜微创手术与传统开腹手术对结直肠癌患者免疫和生理功能影响的临床观察[J].标记免疫分析与临床,2015,22(4):278-281.
[9]刘海涛,关超.3D腹腔镜与传统腹腔镜在肾部分切除术中的临床效果比较[J].蚌埠医学院学报,2016,41(12):1586-1588.
[10]王炳卫,杨国胜,邱晓拂,等.改良单孔多通道腹腔镜前列腺癌根治术不同入路对患者免疫功能的影响[J].实用医学杂志,2016,32(13):2149-2152.
[11]张建斌.新辅助化疗联合腹腔镜手术治疗进展期胃癌的临床疗效及对患者围手术期免疫功能的影响[J].河北医药,2015,37(19):2904-2907.
[12]邹文凯.腹腔镜与开腹胃癌手术对患者术后免疫功能及细胞因子含量影响的对比研究[J].中国医学装备,2015,12(5):46-49.
[13]黄文伟,童仕伦,郑勇斌.腹腔镜胃癌根治术对机体免疫功能、应激反应及微转移的影响[J].现代消化及介入诊疗,2015,20(6):682-685.
[14]陈丽红,邓新粮,杨春桃.阴式与开腹子宫手术前后患者体液免疫细胞免疫功能的影响对比分析[J].山西医药杂志,2015,44(5):570-573.
[15]周文秀,刘芳,杨俊.炎性反应和交感神经系统在慢性心力衰竭大鼠中枢调控中的相互作用[J].解放军医药杂志,2017,29(1):31-34.
[16]Cole SW,Nagaraja AS,Lutgendorf SK,et al.Sympathetic nervous system regulation of the tumour microenvironment[J].Nat Rev Cancer,2015,15(9):563-572.
[17]Barbaros U,Aksakal N,Tukenmez M,et al.Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura:Clinical comparative study[J].J Minim Access Surg,2015,11(3):172-176.
[18]蔡立军.腹腔镜与开腹肝切除术对单核细胞HLA-DR表达和细胞免疫功能影响的比较[J].中国内镜杂志,2015,21(7):684-688.
[19]汪昱,游红勇,刘东涛,等.腹腔镜微创远端胃癌D2根治术治疗老年胃癌的效果及其对免疫功能、低氧诱导因子-1α和结肠癌转移相关基因1表达的影响[J].中国医药导报,2016,13(8):21-24.
[20]张治国,薛慧婧,宋仕茂,等.腹腔镜根治术治疗胃癌的效果观察及其免疫功能和应激炎性因子的变化情况分析[J].胃肠病学和肝病学杂志,2015,24(6):724-727.
[2]刘宏斌,韩晓鹏,朱万坤,等.腹腔镜在进展期胃癌中的应用[J].医学研究杂志,2011,40(3):48-50.
[3]孙小飞,何子锐.腹腔镜与开腹根治术对进展期胃癌患者免疫及应激水平的影响[J].海南医学院学报,2016,22(22):2721
[4]王盼,杨秀春,刘小宇,等.腹腔镜胃癌根治术治疗进展期胃癌对患者血清应激炎症因子的影响[J].医学临床研究,2016,33(9):1798-1800.
[5]钟惠,江英强,尹亚岚,等.麻醉方式对胃癌患者术后呼吸道感染及T淋巴细胞和应激水平的影响[J].中华医院感染学杂志,2017,27(3):609-612.
[6]韩闻卿,姜雅秋.应激时中枢性胰高血糖素样肽1对下丘脑-垂体-肾上腺轴作用的研究进展[J].医学综述,2016,22(19):3753-3756.
[7]杜建军,王园园,郭雄飞,等.腹腔镜手术治疗结肠癌的围术期应激反应及免疫功能观察[J].结直肠肛门外科,2015,21(6):413-417.
[8]汤雪峰,李财宝,刘岗,等.腹腔镜微创手术与传统开腹手术对结直肠癌患者免疫和生理功能影响的临床观察[J].标记免疫分析与临床,2015,22(4):278-281.
[9]刘海涛,关超.3D腹腔镜与传统腹腔镜在肾部分切除术中的临床效果比较[J].蚌埠医学院学报,2016,41(12):1586-1588.
[10]王炳卫,杨国胜,邱晓拂,等.改良单孔多通道腹腔镜前列腺癌根治术不同入路对患者免疫功能的影响[J].实用医学杂志,2016,32(13):2149-2152.
[11]张建斌.新辅助化疗联合腹腔镜手术治疗进展期胃癌的临床疗效及对患者围手术期免疫功能的影响[J].河北医药,2015,37(19):2904-2907.
[12]邹文凯.腹腔镜与开腹胃癌手术对患者术后免疫功能及细胞因子含量影响的对比研究[J].中国医学装备,2015,12(5):46-49.
[13]黄文伟,童仕伦,郑勇斌.腹腔镜胃癌根治术对机体免疫功能、应激反应及微转移的影响[J].现代消化及介入诊疗,2015,20(6):682-685.
[14]陈丽红,邓新粮,杨春桃.阴式与开腹子宫手术前后患者体液免疫细胞免疫功能的影响对比分析[J].山西医药杂志,2015,44(5):570-573.
[15]周文秀,刘芳,杨俊.炎性反应和交感神经系统在慢性心力衰竭大鼠中枢调控中的相互作用[J].解放军医药杂志,2017,29(1):31-34.
[16]Cole SW,Nagaraja AS,Lutgendorf SK,et al.Sympathetic nervous system regulation of the tumour microenvironment[J].Nat Rev Cancer,2015,15(9):563-572.
[17]Barbaros U,Aksakal N,Tukenmez M,et al.Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura:Clinical comparative study[J].J Minim Access Surg,2015,11(3):172-176.
[18]蔡立军.腹腔镜与开腹肝切除术对单核细胞HLA-DR表达和细胞免疫功能影响的比较[J].中国内镜杂志,2015,21(7):684-688.
[19]汪昱,游红勇,刘东涛,等.腹腔镜微创远端胃癌D2根治术治疗老年胃癌的效果及其对免疫功能、低氧诱导因子-1α和结肠癌转移相关基因1表达的影响[J].中国医药导报,2016,13(8):21-24.
[20]张治国,薛慧婧,宋仕茂,等.腹腔镜根治术治疗胃癌的效果观察及其免疫功能和应激炎性因子的变化情况分析[J].胃肠病学和肝病学杂志,2015,24(6):724-727.