快速康复外科对老年结直肠癌患者免疫功能及炎性反应的影响  

Effect of fast tract surgery on immune and inflammatory reaction of elder patients with colorectal cancer

作　　者：马磊 王立凤 丁克[2] 刘广余 张丹丹 

机构地区：[1]山东省枣庄市立第四医院外科,277599 [2]山东中医药大学附属医院肛肠科

出　　处：《中华胃肠外科杂志》2014年第12期1223-1226,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：比较快速康复外科（FTS）与常规围手术期处理方法对老年结直肠癌患者术后免疫功能恢复和炎性应激反应及临床疗效的影响。方法前瞻性纳入2010年2月至2013年8月入住山东省枣庄市立第四医院外科的诊断明确的65岁以上老年结直肠癌患者，按随机数字表法分为快速康复外科组（快速康复组）与常规处理组（常规组）。比较手术前后两组患者T细胞亚群、炎性反应指标和脏器功能指标的变化及两组的差异及临床疗效。结果入组患者144例，年龄（76．5±4．8）岁。快速康复组和常规组各72例，两组患者临床基线资料差异无统计学意义（P＞0．05）。术后第3天，两组患者CD^4＋和CD^8＋均较术前上升（P＜0．05），但快速康复组术后CD^4＋较常规组上升幅度明显（P＝0．003），CD^8＋较常规组明显降低（P＝0．005）；快速康复组CD^4＋／CD^8＋比值较术前增加，并明显高于常规组（P＝0．001）；两组患者炎性反应指标水平均较术前明显上升（P＜0．05），但快速康复组变化幅度小于常规组（P＜0．05）；两组患者肌酐、钠尿肽和肌钙蛋白与术前比较，均明显升高（P＜0．05），但快速康复组升高幅度较常规组小（P＜0．05）。快速康复组患者术后开始进食时间、肛门排气时间、首次排粪时间均较常规组提前，围手术期恶心呕吐发生率和切口感染率明显降低，术后住院时间以及住院费用减少，差异均有统计学意义（P＜0．05）。结论快速康复外科能减轻老年结直肠癌患者围手术期脏器功能损伤，提高术后细胞免疫功能，降低患者手术应激反应，减少围手术期并发症发生率，提高临床疗效。Objective To compare the effect of rapid rehabilitation surgery （FTS） with the traditional operation method on postoperative immune function recovery , inflammatory reaction and the clinical efficacy in elderly patients with colorectal cancer. Methods A total of 144 elderly patients （older than 65 years） diagnosed as colorectal cancer in our department from February 2010 to August 2013 were prospectively enrolled in the study. According to the order of admission , patients were randomly divided into the fast track surgery group （72 cases, study group）, and the traditional operation group （72 cases, control group）. Preoperative and postoperative T cell subsets, inflammatory index and organ functional parameters were detected and compared. Result Basal clinical data of the two groups had no significant differences （all P〉0.05）. Three days after operation, CD^4＋ and CD^8＋ in both groups increased compared to preoperative levels （P〈0.05）, while the study group had greater increasing amplitude of CD^4＋（t=1.685, P=0.003）, and lower CD^8＋（t=1.145, P=0.005） than the control group. CD^4＋/CD^8＋ increased in the study group compared to preoperation and significantly higher than that in the control group （P=0.001）. Inflammatory stress indexes were significantly increased, while study group had smaller amplitude than the control group. Serum creatinine , B-natriuretic peptide and Troponin-T increased after operation , while the study group had smaller amplitude than the control group （P〈0.05）. The study group showed faster resumption of oral intake, quicker bowel function return, time to first defecation, hospital stay, lower incidences of nausea, vomiting, incision infection, and less cost of hospitalization. All the differences were significant （all P〈0.05）. Conclusion Fast track surgery can effectively protect the perioperative organ function, increase postoperative immune function, decrease inflammation stress reaction, reduce perioperative morbidity of comp

关 键 词：结直肠肿瘤 老年 快速康复外科 炎性反应 免疫功能 

分 类 号：R735.34[医药卫生—肿瘤]