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  

Comparative Study of Immune Function on Laparoscopic-Assisted and Open D2 Gastrectomy for Advanced Gastric Cancer

作　　者：刘江文[1] 孙琳[2] 仝德峰[1] 夏军强[1] 龚建军[1] 邓昌辉[1] 陈雪玲[3] 

机构地区：[1]石河子市人民医院普外科,新疆石河子832000 [2]大连市中心医院胃肠外科,辽宁大连116033 [3]石河子大学医学院免疫实验室,新疆石河子832000

出　　处：《中国普外基础与临床杂志》2014年第10期1232-1236,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：兵团重点领域科技攻关项目基金资助(项目编号:2012BA034)~~

摘　　要：目的探讨腹腔镜与开腹手术对进展期胃癌患者围手术期手术疗效及免疫功能的影响。方法对2012年1月至2013年10月期间共53例进展期胃癌进行前瞻性研究,采用数字表法,随机分为腹腔镜辅助胃癌根治术(腹腔镜组)27例和开腹胃癌根治术(开腹组)26例,比较2组的临床指标恢复情况。分别于术前1 d、术后第1天及第7天采用流式细胞仪测定患者外周血T细胞亚群CD3、CD4+、CD8+及CD4+/CD8+的比值;采用免疫比浊法检测免疫球蛋白IgG、IgA、IgM及C反应蛋白(CRP)的变化,并进行对比分析。结果腹腔镜组手术平均用时长于开腹组(P<0.05),但在术中出血量、术后肛门排气时间、下床活动时间及术后住院时间方面腹腔镜组均优于开腹组(P均<0.05);术中平均每例清扫淋巴结数目及首次进流食时间2组接近(P>0.05)。术后第1天及第7天,2组外周血CD3、CD4+及CD8+检测结果较术前均下降(P<0.01,P<0.05);术后第1天2组免疫球蛋白IgG、IgA及IgM水平较术前均下降(P<0.05),术后第7天腹腔镜组免疫球蛋白水平已接近术前(P>0.05),而开腹组仍低于术前水平(P<0.05);术后第1天及第7天2组CRP水平均高于术前(P<0.01,P<0.05)。腹腔镜组与开腹组之间相比,术后第1天上述指标的变化差异无统计学意义(P>0.05);术后第7天,2组的各项指标均有所恢复,但腹腔镜组优于开腹组(P<0.05,IgA除外)。结论腹腔镜胃癌手术近期临床疗效优于开腹手术,而且对围手术期机体细胞免疫和体液免疫功能的恢复也具有较明显的优势。Objective To compare the clinical recovery and immune response between laparoscopic-assisted and open D2 gastrectomy for advanced gastric cancer. Methods The clinical data of 53 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively. According to random number table, patients were randomly divided into laparoscopic-assisted group(LA group, n=27) and open operation group(OO group, n=26). Operative time,blood loss, time to passage of fl atus, time to resume soft diet, after bed time, postoperative hospital stay, and number of retrieved lymph nodes were compared respectively between the two groups. The changes in CD3, CD4+, CD8+, IgG, IgA, IgM, and CRP were examined respectively by using fl ow cytometry and immunoturbidimetric assays on the preoperative day 1, and on the postoperative day 1 and 7. Results The operative time was longer signifi cantly in LA group than that in OO group(P<0.05). The mean blood loss, the fi rst fl atus time, after bed time, and postoperative hospital stay in the two groups were all different statistically(P<0.05), and all were better in LA group. However, the mean number of retrieved lymph nodes and the time to resume soft diet were not signifi cantly different in the two groups(P>0.05). On the day 1 and 7 after operation, the CD3, CD4+, and CD8+ signifi cantly decreased as compared with those preoperatively in two groups(P< 0.01, P< 0.05). On the day 1 after operation, the levels of IgG, IgA, and IgM signifi cantly decreased as compared with those preoperatively in two groups(P<0.05). Those immunoglobulin in LA group recovered to close to the level before surgery, but in OO group sustained lower level(P<0.05). On the day 1 and 7 after operation, CRP level signifi cantly increased as compared with those preoperatively in two groups(P<0.01, P<0.05). Those changes of above index were not signifi cantly different between the LA group and OO group on the day 1 after operation(P>0.05). All index recovered gradually in the two groups on the day 7 aft

关 键 词：进展期胃癌 胃切除术 腹腔镜 T细胞亚群 免疫球蛋白 

分 类 号：R735.2[医药卫生—肿瘤]