加速康复外科联合腹腔镜手术对胃癌患者术后肠道生物屏障稳定性的影响研究
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摘要
目的探讨加速康复外科(ERAS)联合腹腔镜手术对于胃癌患者术后肠道生物屏障稳定性、免疫功能及应激反应的临床研究。方法回顾性分析2016年1月至2018年6月期间收治的胃癌患者88例资料,患者均进行腹腔镜胃癌根治术治疗,按照治疗干预方案不同分为ERAS组和传统组。ERAS组42例患者采用ERAS干预,传统组46例患者给予常规治疗。采用SPSS 20.0进行数据分析,术后各临床指标、肠道菌属数目等计量资料采用■表示,独立t检验;术后并发症、病理分级等计数资料采用χ~2检验;P<0.05表示差异有统计学意义。结果 ERAS组患者术后肛门通气时间、发热时间、下床活动时间、首次进食时间、住院时间显著短于传统组(P<0.05);术后ERAS组患者粪便各菌属数量明显多于传统组(P<0.05);术后3 d ERAS组患者血清CD4~+、CD4~+/CD8~+、IgG、IgM、IgA明显优于传统组(P<0.05);术后ERAS组患者应激反应较传统组低,血清IL-6、CRP、TNF-α水平明显低于对照组,差异均有统计学意义(P<0.05)。结论加速康复外科联合腹腔镜手术对于胃癌患者术后肠道生物屏障、术后免疫功能、应激反应等具有重大意义,且可有效促进患者术后康复,值得临床推广。
Objective To investigate the impact of enhanced recovery after surgery(ERAS) combined with laparoscopic surgery on intestinal biological barrier stability,immune function and stress response of patients with gastric cancer. Methods From January 2016 to June 2018, clinical data of 88 patients with gastric cancer were retrospectively analyzed. All of 88 patients received laparoscopic radical gastrectomy. According to the intervention scheme, 88 paients were divided into ERAS group(n=42) and traditional group(n=46). Spss20.0 software was used for data analysis.Measurement data such asnumber of intestinal bacteriawere presented as mean+standard deviation and were examined by using t test. Postoperative complicationrate, pathological grade and other count data were expressed as %, and were compared with χ~2 test. P<0.05 was considered as significant difference. Results Time of bowel movement, fever,ambulation,recovery of oral nutrition intake and time of hospitalization in ERAS group were significantly shorter than those in traditional group respectively(P<0.05).Number of fecal bacteria in ERAS group was significantly higher than that in traditional group(P<0.05).Peripheral CD4~+T cells, CD4/CD8~+T cells and serum IgG, IgM, IgA in ERAS group were significantly better than those in traditional group 3 days after operation(P<0.05). The stress response in ERAS group was lower than that in traditional group, and the serum IL-6, CRP, TNF-α level were significantly lower than those in control group respectively(P<0.05). Conclusion ERAS combined with laparoscopic surgery is of great significance for postoperative intestinal biological barrier, postoperative immune function and stress response in patients with gastric cancer.
Objective To investigate the impact of enhanced recovery after surgery(ERAS) combined with laparoscopic surgery on intestinal biological barrier stability,immune function and stress response of patients with gastric cancer. Methods From January 2016 to June 2018, clinical data of 88 patients with gastric cancer were retrospectively analyzed. All of 88 patients received laparoscopic radical gastrectomy. According to the intervention scheme, 88 paients were divided into ERAS group(n=42) and traditional group(n=46). Spss20.0 software was used for data analysis.Measurement data such asnumber of intestinal bacteriawere presented as mean+standard deviation and were examined by using t test. Postoperative complicationrate, pathological grade and other count data were expressed as %, and were compared with χ~2 test. P<0.05 was considered as significant difference. Results Time of bowel movement, fever,ambulation,recovery of oral nutrition intake and time of hospitalization in ERAS group were significantly shorter than those in traditional group respectively(P<0.05).Number of fecal bacteria in ERAS group was significantly higher than that in traditional group(P<0.05).Peripheral CD4~+T cells, CD4/CD8~+T cells and serum IgG, IgM, IgA in ERAS group were significantly better than those in traditional group 3 days after operation(P<0.05). The stress response in ERAS group was lower than that in traditional group, and the serum IL-6, CRP, TNF-α level were significantly lower than those in control group respectively(P<0.05). Conclusion ERAS combined with laparoscopic surgery is of great significance for postoperative intestinal biological barrier, postoperative immune function and stress response in patients with gastric cancer.
引文
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[2] 胡建昆,赵林勇.腹腔镜胃癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(2):91-94.
[3] 陈罗飞,马焌峰,樊勇,等.腹腔镜下胃癌根治术的现状与进展[J].中国肿瘤,2018,27(2):136-141.
[4] 臧潞,马君俊,郑民华.腹腔镜胃癌手术的争议与共识[J].中国实用外科杂志,2018,38(2):163-166.
[5] 宋康颉,章琪,何承龙,等.腹腔镜与开腹胃癌根治术后早期肠内营养的对比研究[J].肠外与肠内营养,2018,25(2):81-85,90.
[6] 朱军民,陈刚,秦俊杰,等.糖代谢异常和炎症对胃癌的影响[J].兰州大学学报(医学版),2018,44(1):83-88.
[7] 陈心足,胡建昆.胃癌规范化诊疗进展[J].华西医学,2018,33(4):379-384.
[8] 杨宝玉,林小燕.胃癌根治术后辅助治疗的疗效及预后因素分析[J].现代肿瘤医学,2018,26(18):2901-2906.
[9] 耿龙龙,任鹏,李延海,等.胃癌治疗现状及新进展[J].医学理论与实践,2017,30(12):1744-1746,1749.
[10] 江志伟,黎介寿.重视胃癌手术应用加速康复外科的研究与推广[J].外科理论与实践,2016,21(1):25-27.
[11] 戚宇锋,苏文.基于免疫学的胃肠道微生态与胃癌相关研究进展[J].中国微生态学杂志,2018,30(2):216-221,239.
[12] 石春卫,陈毅秋,胡静涛,等.肠道微生物群对宿主免疫系统发育和功能的调节[J].中国免疫学杂志,2016,32(10):1536-1540.
[13] 张磊,吴永娜,陈拓,等.肠道微生物菌群与消化道肿瘤关系的研究进展[J].微生物学杂志,2018,38(3):84-90.
[14] 邓琦蕾,申元英.肠道微生物群在脑-肠-微生物轴中作用机制的研究进展[J].实用医学杂志,2017,33(14):2404-2407.
[15] 李曌,徐东,王紫倩,等.肠道微生物在自身免疫性疾病中的作用[J].中华临床免疫和变态反应杂志,2017,11(1):61-68.
[16] 刘应玲,陈思,洪海鸥,等.血清胃蛋白酶原、胃泌素17和幽门螺杆菌检测在胃癌前病变诊断中的价值[J].安徽医科大学学报,2017,52(8):1227-1231.
[17] 刘桂伟,任维聃,姜国胜.谷氨酰胺强化肠内营养对结肠癌患者左半结肠切除术后肠通透性及感染并发症的作用[J].中国全科医学,2018,21(5):526-530.
[18] 伍彦辉,田玉芝,董韶华,等.中药对高脂血症性重症急性胰腺炎大鼠肠黏膜通透性及甘油三酯影响[J].中国中西医结合外科杂志,2018,24(4):461-465.
[19] 吕震.胃肠手术中患者给予快速康复治疗后的疗效分析[J/CD].中华普外科手术学杂志(电子版),2017,11(4):341-344.
[2] 胡建昆,赵林勇.腹腔镜胃癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(2):91-94.
[3] 陈罗飞,马焌峰,樊勇,等.腹腔镜下胃癌根治术的现状与进展[J].中国肿瘤,2018,27(2):136-141.
[4] 臧潞,马君俊,郑民华.腹腔镜胃癌手术的争议与共识[J].中国实用外科杂志,2018,38(2):163-166.
[5] 宋康颉,章琪,何承龙,等.腹腔镜与开腹胃癌根治术后早期肠内营养的对比研究[J].肠外与肠内营养,2018,25(2):81-85,90.
[6] 朱军民,陈刚,秦俊杰,等.糖代谢异常和炎症对胃癌的影响[J].兰州大学学报(医学版),2018,44(1):83-88.
[7] 陈心足,胡建昆.胃癌规范化诊疗进展[J].华西医学,2018,33(4):379-384.
[8] 杨宝玉,林小燕.胃癌根治术后辅助治疗的疗效及预后因素分析[J].现代肿瘤医学,2018,26(18):2901-2906.
[9] 耿龙龙,任鹏,李延海,等.胃癌治疗现状及新进展[J].医学理论与实践,2017,30(12):1744-1746,1749.
[10] 江志伟,黎介寿.重视胃癌手术应用加速康复外科的研究与推广[J].外科理论与实践,2016,21(1):25-27.
[11] 戚宇锋,苏文.基于免疫学的胃肠道微生态与胃癌相关研究进展[J].中国微生态学杂志,2018,30(2):216-221,239.
[12] 石春卫,陈毅秋,胡静涛,等.肠道微生物群对宿主免疫系统发育和功能的调节[J].中国免疫学杂志,2016,32(10):1536-1540.
[13] 张磊,吴永娜,陈拓,等.肠道微生物菌群与消化道肿瘤关系的研究进展[J].微生物学杂志,2018,38(3):84-90.
[14] 邓琦蕾,申元英.肠道微生物群在脑-肠-微生物轴中作用机制的研究进展[J].实用医学杂志,2017,33(14):2404-2407.
[15] 李曌,徐东,王紫倩,等.肠道微生物在自身免疫性疾病中的作用[J].中华临床免疫和变态反应杂志,2017,11(1):61-68.
[16] 刘应玲,陈思,洪海鸥,等.血清胃蛋白酶原、胃泌素17和幽门螺杆菌检测在胃癌前病变诊断中的价值[J].安徽医科大学学报,2017,52(8):1227-1231.
[17] 刘桂伟,任维聃,姜国胜.谷氨酰胺强化肠内营养对结肠癌患者左半结肠切除术后肠通透性及感染并发症的作用[J].中国全科医学,2018,21(5):526-530.
[18] 伍彦辉,田玉芝,董韶华,等.中药对高脂血症性重症急性胰腺炎大鼠肠黏膜通透性及甘油三酯影响[J].中国中西医结合外科杂志,2018,24(4):461-465.
[19] 吕震.胃肠手术中患者给予快速康复治疗后的疗效分析[J/CD].中华普外科手术学杂志(电子版),2017,11(4):341-344.