老年胃癌患者腹腔镜手术治疗效果及免疫球蛋白、T淋巴细胞亚群的变化观察  

Effect of laparoscopic minimally invasive surgery on the elderly patients with gastric cancer and the changes of immunoglobulin and T lymphocyte subsets

作　　者：樊华[1] 高永涛[1] 卢荣增 林朝阳 袁江涛[1] FAN Hua;GAO Yong-tao;LU Zeng-rong;LIN Chao-yang;YUAN Jiang-tao(Department of Gastrointestinal Surgery,Affiliated Hospitalof Yan'an University,Shaanxi Yan'an 716000,China)

机构地区：[1]延安大学附属医院胃肠外科,陕西延安716000

出　　处：《中国医刊》2018年第12期1352-1356,共5页Chinese Journal of Medicine

摘　　要：目的探讨腹腔镜手术治疗老年胃癌的临床效果及对免疫球蛋白、T淋巴细胞亚群水平的影响。方法纳入2015年6月至2016年6月本院收治的92例老年胃癌患者,根据手术方式的不同分为腹腔镜组和开腹组,每组46例。腹腔镜组采用腹腔镜手术治疗,开腹组采用传统开腹手术治疗。比较两组患者的一般情况,手术前后免疫球蛋白、T淋巴细胞亚群水平,术后并发症发生情况及随访结果。结果腹腔镜组手术时间明显长于开腹组,切口长度、术中出血量、淋巴结清扫数明显低于开腹组,而术后胃肠功能恢复时间、术后进流食时间、术后住院时间明显短于开腹组(P<0.05,P<0.01)。术前两组免疫球蛋白、T淋巴细胞亚群水平比较差异无显著性,术后腹腔镜组IgA、IgG、IgM水平,CD3^+、CD4^+T淋巴细胞百分比及CD4^+/CD8^+比值明显高于开腹组,CD8^+T淋巴细胞百分比明显低于开腹组,差异均有显著性(P<0.05,P<0.01)。腹腔镜组术后并发症发生率为13.0%,明显低于开腹组的63.0%,差异有显著性(P<0.05)。两组患者术后1年存活率、肿瘤复发率比较差异无显著性(P>0.05)。结论老年胃癌患者采用腹腔镜手术治疗可获得良好的临床效果,且有助于改善患者免疫功能,安全性好。Objective To explore the effect of laparoscopic minimally invasive surgery on the elderly patients with gastric cancer and thechanges of immunoglobulin and T lymphocyte subsets. Method 92 elderly patients with gastric cancer who were treated in hospital fromJune 2015 to June 2016 were selected. According to the different surgical methods, they were divided into laparoscopic group (n = 46) andopen group (n=46). Patients in laparoscopic group were treated with laparoscopic minimally invasive surgery, while patients in open groupwere treated with traditional open surgery. The general condition, the changes of immunoglobulin, T lymphocyte subsets levels beforeand after treatment, postoperative complications and follow-up of the two groups were compared. Result In the laparoscopic group, theoperation time was significantly longer than that in the open group. The length of the incision, the amount of intraoperative blood loss, andthe number of lymph node dissection were significantly lower than those in the open group. The postoperative gastrointestinal functionrecovery time, postoperative feeding time, and postoperative hospital stay were significantly shorter. In the open group (P<0.05, P<0.01).There were no significant differences in the levels of immunoglobulin and T lymphocyte subsets between the two groups before operation.The levels of IgA, IgG, IgM, CD3+, CD4+ T cells and CD4+/CD8+ ratio in the laparoscopic group were significantly higher than those in theopen group. The percentage of CD8+ T cells was significantly lower than that of the open group, and the difference was significant (P<0.05,P<0.01). The incidence of postoperative complications in the laparoscopic group was 13.0%, which was significantly lower than that inthe open group (63.0%). The difference was significant (P<0.05). There was no significant difference in survival rate and tumor recurrencerate between the two groups (P>0.05). Conclusion Elderly patients with gastric cancer undergo laparoscopic minimally invasive surgerycan get good clinical r

关 键 词：胃癌 腹腔镜手术 免疫球蛋白 T淋巴细胞亚群 

分 类 号：R735.2[医药卫生—肿瘤]