开腹与腹腔镜胃癌根治术对老年进展期胃癌患者应激反应及免疫功能的影响
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摘要
目的:探讨开腹与腹腔镜胃癌根治术对老年进展期胃癌患者应激反应及免疫功能的影响。方法:2015年4月至2017年6月收治的130例老年进展期胃癌患者,分为腹腔镜组与开腹组,每组65例,观察两组手术情况,并于术前1 d及术后第1天、第7天检测应激反应及免疫功能指标的变化。结果:腹腔镜组手术时间长于开腹组,术中出血量、术后肛门排气时间、住院时间均优于开腹组(P<0.05),两组术中淋巴结清扫数量差异无统计学意义(P>0.05)。两组患者术前血清IL-6、NO、CRP、CD4~+、CD8~+及CD~4+/CD~8+水平差异无统计学意义(P>0.05);与术前相比,术后第1天、第7天两组患者血清IL-6、NO及CRP水平升高(P<0.05),但腹腔镜组低于开腹组(P<0.05)。术后第1天、第7天,两组患者CD4~+、CD~8+及CD~4+/CD~8+均下降,腹腔镜组高于开腹组(P<0.05)。结论:腹腔镜胃癌根治术治疗老年进展期胃癌,可明显减轻患者机体应激反应及对免疫功能的抑制,更利于术后恢复。
Objective: To investigate the influence of laparotomy and laparoscopic radical gastrectomy on stress reaction and immune function in elderly patients with advanced gastric cancer. Methods: A total of 130 elderly patients with advanced gastric cancer treated from Apr. 2015 to Jun. 2017 were recruited. According to the surgical methods,all the patients were divided into laparoscopic group and laparotomy group( 65 cases in each group). The operation information of the two groups was observed,and the changes of stress reaction and immune function indexes before operation,1 d and 7 d after operation were detected. Results: Compared with the patients in laparotomy group,the operation time of laparoscopic group was significantly prolonged,the amount of bleeding was significantly reduced,anal exhaust time and hospitalization time were significantly shorter( P < 0. 05). There was no significant difference in the number of harvested lymph nodes between the two groups( P > 0. 05). The preoperative serum levels of IL-6,NO,CRP,CD4~+,CD8~+ and CD4~+/CD8~+ were not significantly different between the two groups( P > 0. 05). The serum levels of IL-6,NO,CRP at 1 d,7 d after operation were significantly higher than those before operation in the two groups,and the level of laparoscopic group was significantly lower than that of the laparotomy group( P < 0. 05). The level of CD4~+,CD8~+ and CD4~+/CD8~+ at 1 d and 7 d after operation of the two groups were significantly decreased,and the level of laparoscopic group was significantly higher than that of the laparotomy group( P< 0. 05). Conclusions: Laparoscopic radical gastrectomy for advanced gastric cancer can alleviate the stress response and the inhibition of immune function in elderly patients,which is more conducive to postoperative recovery.
Objective: To investigate the influence of laparotomy and laparoscopic radical gastrectomy on stress reaction and immune function in elderly patients with advanced gastric cancer. Methods: A total of 130 elderly patients with advanced gastric cancer treated from Apr. 2015 to Jun. 2017 were recruited. According to the surgical methods,all the patients were divided into laparoscopic group and laparotomy group( 65 cases in each group). The operation information of the two groups was observed,and the changes of stress reaction and immune function indexes before operation,1 d and 7 d after operation were detected. Results: Compared with the patients in laparotomy group,the operation time of laparoscopic group was significantly prolonged,the amount of bleeding was significantly reduced,anal exhaust time and hospitalization time were significantly shorter( P < 0. 05). There was no significant difference in the number of harvested lymph nodes between the two groups( P > 0. 05). The preoperative serum levels of IL-6,NO,CRP,CD4~+,CD8~+ and CD4~+/CD8~+ were not significantly different between the two groups( P > 0. 05). The serum levels of IL-6,NO,CRP at 1 d,7 d after operation were significantly higher than those before operation in the two groups,and the level of laparoscopic group was significantly lower than that of the laparotomy group( P < 0. 05). The level of CD4~+,CD8~+ and CD4~+/CD8~+ at 1 d and 7 d after operation of the two groups were significantly decreased,and the level of laparoscopic group was significantly higher than that of the laparotomy group( P< 0. 05). Conclusions: Laparoscopic radical gastrectomy for advanced gastric cancer can alleviate the stress response and the inhibition of immune function in elderly patients,which is more conducive to postoperative recovery.
引文
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[2]尹作文,喻军,王永,等.腹腔镜辅助远端胃癌根治术治疗远端胃癌的疗效观察与安全性评估[J].实用癌症杂志,2014,29(4):400-402.
[3]黄飞,韦杨年,卢榜裕,等.腹腔镜辅助下胃癌根治术与开腹胃癌根治术疗效的对比研究[J].中国内镜杂志,2012,18(10):1018-1022.
[4]Alsina M,Moehler M,Hierro C,et al.Immunotherapy for Gastric Cancer:A Focus on Immune Checkpoints[J].Target Oncol,2016,11(4):469-477.
[5]Veenhof AA,Vlug MS,van der Pas MH,et al.Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial[J].Ann Surg,2012,255(2):216-221.
[6]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3)[S].Gastric Cancer,2011,14(2):113-123.
[7]Lan H,Zhu N,Lan Y,et al.Laparoscopic gastrectomy for gastric cancer in China:an overview[J].Hepatogastroenterology,2015,62(137):234-239.
[8]仝德峰,刘江文,孙琳,等.进展期胃癌腹腔镜辅助D2根治术的临床疗效分析[J].中国普通外科杂志,2015,24(8):1201-1204.
[9]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):724-726.
[10]危少华,李保磊,李伟,等.腹腔镜胃癌根治术对机体全身炎性反应和免疫功能的影响及其临床意义[J].苏州大学学报(医学版),2012,32(6):868-871.
[11]余伯成.腹腔镜胃癌D2根治术和开腹胃癌D2根治术中患者炎症反应比较[J].临床与病理杂志,2015,35(7):1298-1303.
[12]严建宇,陈伦牮,杨钦清,等.腹腔镜胃癌根治术对T细胞亚群及CRP、IL-6表达水平的影响[J].武警后勤学院学报(医学版),2013,22(7):595-597.
[13]Ma Z,Bao X,Gu J.Effects of laparoscopic radical gastrectomy and the influence on immune function and inflammatory factors[J].Exp Ther Med,2016,12(2):983-986.
[14]刘江文,孙琳,仝德峰,等.进展期胃癌腹腔镜辅助与开腹胃癌根治术对患者围手术期免疫功能影响的对比研究[J].中国普外基础与临床杂志,2014,21(10):1232-1236.
[15]Takaya S,Saito H,Ikeguchi M.Upregulation of Immune Checkpoint Molecules,PD-1 and LAG-3,on CD4+and CD8+T Cells after Gastric Cancer Surgery[J].Yonago Acta Med,2015,58(1):39-44.
[16]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):2721-2723.