进展期胃癌腹腔镜手术和开腹手术疗效及机体应激免疫反应对比研究
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摘要
目的探讨进展期胃癌腹腔镜手术和开腹手术的疗效及机体应激免疫反应。方法选择进展期胃癌腹腔镜手术患者80例作为腹腔镜组,进展期胃癌开腹手术患者80例作为开腹组。收集两组患者年龄、性别、肿瘤TNM分期、肿瘤部位、手术方式、淋巴结清扫个数、手术时间、术中失血量、住院时间、肛门排气时间、术后并发症等临床资料。测定血清C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平,测定外周血补体C3、C4、Ig M、Ig G、Ig A水平。结果两组患者资料比较差异均无统计学意义(P> 0. 05)。腹腔镜组术中失血量、住院时间、肛门排气时间以及术后并发症发生率均优于开腹组(P <0. 05),两组手术时间比较差异无统计学意义(P> 0. 05)。术后1 d和术后7 d腹腔镜组血清CRP、IL-6、TNF-α水平低于开腹组;两组患者不同时间点血清CRP、IL-6、TNF-α水平差异有统计学意义(P <0. 05),两组患者术后血清CRP、IL-6、TNF-α水平升高,术后7 d开腹组未降至正常水平,腹腔镜组降至正常水平。两组患者C3、C4、Ig A比较差异无统计学意义(P> 0. 05),Ig M、Ig G比较差异有统计学意义(P <0. 05),术后7 d腹腔镜组Ig M、Ig G均高于开腹组;两组患者不同时间点C3、C4比较差异无统计学意义(P> 0. 05);两组不同时间点Ig M、Ig G、Ig A比较差异有统计学意义(P <0. 05),术后Ig M、Ig G、Ig A水平下降,开腹组术后7 d未恢复术前水平,腹腔镜组术后7 d恢复术前水平。结论与开腹手术相比,进展期胃癌腹腔镜手术近期疗效更显著,对机体应激和免疫反应影响小。
Objective To investigate the efficacy and body stress immune response of laparoscopic surgery and laparotomy on patients with advanced gastric cancer. Methods 80 patients of advanced gastric cancer laparoscopic surgery were selected as laparoscopic group,and 80 cases of patients with advanced gastric cancer underwent open surgery were selected as laparotomy group from January 2015 to January 2017 in our hospital. The age,sex,tumor TNM staging,tumor location,surgical procedure,lymph node dissection,operation time,intraoperative blood loss,hospital stay,anal exhaust time,postoperative complications and other clinical data were collected. The levels of serum C-reactive protein( CRP),interleukin-6( IL-6) and tumor necrosis factor-ɑ( Tumor necrosis factor-αTNF-α) were measured. The levels of C3,C4,Ig M,Ig G and Ig A in peripheral blood were measured. Results There were no significant differences between the two groups. The time of blood loss,hospital stay time,exhaust time and the incidence of postoperative complications in laparoscopic group were lower than that in laparotomy group. There was no significant difference in the operation time between the two groups. The levels of serum CRP,IL-6 and TNF-α in laparoscopic group were lower than those in laparotomy group at 1 day and 7 days after operation. There were significant differences in serum CRP,IL-6 and TNF-αamong different time points in the two groups( P < 0. 05). The levels of serum CRP,IL-6 and TNF-α after operation were increased in both groups,at 7 days after operation,the serum levels of CRP,IL-6 and TNF-α in laparotomy group did not decrease to normal levels,the level of serum CRP,IL-6 and TNF-α in laparoscopic group decreased to normal level. There were no significant difference in C3,C4 and Ig A between the two groups( P > 0. 05),the difference of Ig M,Ig G was statistically significant( P < 0. 05). The Ig M and Ig G in laparoscopic group were higher than those in the open group at 7 days after operation. There were no significant difference in C3 and C4 among different time points in laparotomy group and laparoscopic group( P > 0. 05).Postoperative Ig M,Ig G,Ig A levels decreased,in the laparotomy group,the preoperative level at 7 days after operation was not restored,in the Laparoscopic group,the preoperative level at 7 days after operation was restored. Conclusion Compared with laparotomy,advanced gastric cancer laparoscopic surgery is more effective,the impact of body stress and immune response is small.
Objective To investigate the efficacy and body stress immune response of laparoscopic surgery and laparotomy on patients with advanced gastric cancer. Methods 80 patients of advanced gastric cancer laparoscopic surgery were selected as laparoscopic group,and 80 cases of patients with advanced gastric cancer underwent open surgery were selected as laparotomy group from January 2015 to January 2017 in our hospital. The age,sex,tumor TNM staging,tumor location,surgical procedure,lymph node dissection,operation time,intraoperative blood loss,hospital stay,anal exhaust time,postoperative complications and other clinical data were collected. The levels of serum C-reactive protein( CRP),interleukin-6( IL-6) and tumor necrosis factor-ɑ( Tumor necrosis factor-αTNF-α) were measured. The levels of C3,C4,Ig M,Ig G and Ig A in peripheral blood were measured. Results There were no significant differences between the two groups. The time of blood loss,hospital stay time,exhaust time and the incidence of postoperative complications in laparoscopic group were lower than that in laparotomy group. There was no significant difference in the operation time between the two groups. The levels of serum CRP,IL-6 and TNF-α in laparoscopic group were lower than those in laparotomy group at 1 day and 7 days after operation. There were significant differences in serum CRP,IL-6 and TNF-αamong different time points in the two groups( P < 0. 05). The levels of serum CRP,IL-6 and TNF-α after operation were increased in both groups,at 7 days after operation,the serum levels of CRP,IL-6 and TNF-α in laparotomy group did not decrease to normal levels,the level of serum CRP,IL-6 and TNF-α in laparoscopic group decreased to normal level. There were no significant difference in C3,C4 and Ig A between the two groups( P > 0. 05),the difference of Ig M,Ig G was statistically significant( P < 0. 05). The Ig M and Ig G in laparoscopic group were higher than those in the open group at 7 days after operation. There were no significant difference in C3 and C4 among different time points in laparotomy group and laparoscopic group( P > 0. 05).Postoperative Ig M,Ig G,Ig A levels decreased,in the laparotomy group,the preoperative level at 7 days after operation was not restored,in the Laparoscopic group,the preoperative level at 7 days after operation was restored. Conclusion Compared with laparotomy,advanced gastric cancer laparoscopic surgery is more effective,the impact of body stress and immune response is small.
引文
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[7]Kim EY,Yim HW,Park CH,et al.C-reactive protein can be an early predictor of postoperative complications after gastrectomy forgastric cancer[J].Surg Endosc,2017,31(1):445-454.
[8]Kong F,Gao F,Chen J,et al.Elevated serum C-reactive protein level predicts a poor prognosis for recurrent gastric cancer[J].Oncotarget,2016,7(34):55765-55770.
[9]Zhou F,Cheng L,Qiu LX,et al.Associations of potentially functional variants in IL-6,JAKs and STAT3 with gastric cancer risk in an eastern Chinese population[J].Oncotarget,2016,7(19):28112-28123.
[10]Chen L,Yuan W,Chen Z,et al.Vasoactive intestinal peptide represses activation of tumor-associated macrophages in gastric cancer via regulation of TNFα,IL-6,IL-12 and i NOS[J].Int J Oncol,2015,47(4):1361-1370.
[11]Stubljar D,Jeverica S,Jukic T,et al.The influence of cytokine gene polymorphisms on the risk of developing gastric cancer in patients with Helicobacter pylori infection[J].Radiol Oncol,2015,49(3):256-264.
[12]Chen WK,Ren L,Wei Y,et al.General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgeryby mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients[J].Int J Colorectal Dis,2015,30(4):475-481.
[13]Schrumpf E,Kummen M,Valestrand L,et al.The gut microbiota contributes to a mouse model of spontaneous bile duct inflammation[J].J Hepatol,2017,66(2):382-389.
[14]宗祥龙,季鑫,贾子豫,等.胃癌患者手术前后细胞免疫水平变化与术后感染关系的研究[J].中华医院感染学杂志,2017,27(6):1297-1300.
[2]高慧,姬乐,王敏,等.右美托咪定对胃癌手术患者免疫状况的影响[J].癌症进展,2016,14(8):774-776,779.
[3]Rahmani N,Abbas Hashemi S,Sadeghian I.Impact of gender on cellular immunity following gastrectomy in gastric cancer patients[J].Med Glas(Zenica),2012,9(2):223-226.
[4]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.
[5]Ezhevskaia AA,Prusakova Zh B,Maksimova LP,et al.Effects of epidural anesthesia on stress-induced immune supression during major corrective spinesurgery[J].Anesteziol Reanimatol,2014,59(6):4-9.
[6]夏海荣,钱玉元,钟妮娜,等.加速康复外科对胃癌根治手术病人术后免疫功能和恢复的影响[J].腹部外科,2016,29(5):396-399.
[7]Kim EY,Yim HW,Park CH,et al.C-reactive protein can be an early predictor of postoperative complications after gastrectomy forgastric cancer[J].Surg Endosc,2017,31(1):445-454.
[8]Kong F,Gao F,Chen J,et al.Elevated serum C-reactive protein level predicts a poor prognosis for recurrent gastric cancer[J].Oncotarget,2016,7(34):55765-55770.
[9]Zhou F,Cheng L,Qiu LX,et al.Associations of potentially functional variants in IL-6,JAKs and STAT3 with gastric cancer risk in an eastern Chinese population[J].Oncotarget,2016,7(19):28112-28123.
[10]Chen L,Yuan W,Chen Z,et al.Vasoactive intestinal peptide represses activation of tumor-associated macrophages in gastric cancer via regulation of TNFα,IL-6,IL-12 and i NOS[J].Int J Oncol,2015,47(4):1361-1370.
[11]Stubljar D,Jeverica S,Jukic T,et al.The influence of cytokine gene polymorphisms on the risk of developing gastric cancer in patients with Helicobacter pylori infection[J].Radiol Oncol,2015,49(3):256-264.
[12]Chen WK,Ren L,Wei Y,et al.General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgeryby mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients[J].Int J Colorectal Dis,2015,30(4):475-481.
[13]Schrumpf E,Kummen M,Valestrand L,et al.The gut microbiota contributes to a mouse model of spontaneous bile duct inflammation[J].J Hepatol,2017,66(2):382-389.
[14]宗祥龙,季鑫,贾子豫,等.胃癌患者手术前后细胞免疫水平变化与术后感染关系的研究[J].中华医院感染学杂志,2017,27(6):1297-1300.