单孔腹腔镜胃窦癌根治术对患者围手术期免疫功能的影响  

The effects of single incision laparoscopic radical gastrectomy on the immune function during perioperative period

作　　者：王家兴[1] 黄隆锴 何庆良[1] Wang Jiaxing;Huang Longkai;He Qingliang(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;The First Clinical Medical College of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院胃肠外科一区,福州350005 [2]福建医科大学第一临床学院,福州350005

出　　处：《中华实验外科杂志》2019年第7期1295-1298,共4页Chinese Journal of Experimental Surgery

基　　金：福建省产业技术开发与应用计划引导性项目(2016Y0034).

摘　　要：目的探讨单孔腹腔镜胃窦癌根治术对患者围手术期免疫功能的影响.方法接受单孔腹腔镜的20例与传统五孔腹腔镜手术的20例胃窦癌患者比较两组手术相关指标、术前及术后免疫指标.计量资料以均值±标准差(Mean±SD)表示,符合正态或近似正态分布采用独立样本t检验进行比较;非正态分布资料比较采用Mann-Whitney U检验;计数资料比较采用x^2检验或Fisher精确概率检验.结果两组患者基线资料比较,差异均无统计学意义(t=0.804、0.555、1.203、0.833,P>0.05).单孔组较传统组患者的总切口长度短[(5.11 ±1.53) cm比(10.02±2.31)cm,t=22.581,P<0.01],卧床时间短[(1.01±0.59)d比(2.81±0.74)d,t=12.247,P<0.01],术后疼痛轻(χ^2 =9.690,P<0.05),与术前比较,术后两组血浆内皮素(ET)、C-反应蛋白(CRP)和白细胞介素(IL)-6水平均呈先升高后降低的趋势(t=5.287、6.946,8.169,P<0.05),术后观察组各项细胞免疫功能指标CD4^+ CD25+叉状头/翅膀状螺旋转录因子(Foxp3)^+/CD4^+水平低于对照组(t=5.264、3.951,P均<0.05).全组随访12个月,均未出现局部复发和远处转移率.结论单孔腹腔镜治疗胃窦癌与传统五孔法比较具有术后恢复快、疼痛轻、免疫抑制轻、美容效果好的优势.Objective To investigate the effect of single incision laparoscopic radical gastrectomy in the immune function during perioperative period. MethodsTwenty patients of single incision laparoscopic radical operation (SILS) for gastric cancer and 20 Gastric cancer Patients who underwent t conventional laparoscopic surgery (CLS) from June 2016 to June 2017 were selected as SILS group and CLS group respectively. The immunological indicators were detected before and after surgery. The performance of operation in two groups were compared. ResultsThere was no significant difference in the baseline data between the two groups (t=0.804, 0.555, 1.203, 0.833, P>0.05). The total incision length of the SILS group was shorter than that of the CLS group [(5.11±1.53) cm vs.(10.02±2.31) cm, t=22.581, P<0.01], and shorter time to ambulation [(1.01±0.59) d vs.(2.81±0.74) d, t=12.247, P<0.01], postoperative pain was light (χ^2=9.690, P<0.05). Compared with preoperative, the ET, CRP and IL-6 level of the two groups increased first and then decreased (t=5.287, 6.946, 8.169, P<0.05). The CD4^+ CD25^+ forkhead box P3(Foxp3)^+/CD4^+ levels in the SILS group were higher than those in the CLS group (t=5.264, 3.951, P<0.05). There was no local recurrence and distant metastasis rate in the whole group for 12 months. ConclusionSingle incision laparoscopic treatment of gastric cancer has the advantages of quicker recovery, lighter pain, lighter immunosuppression and good cosmetic effect compared with the CLS group.

关 键 词：单孔腹腔镜 胃癌 CD4^+ CD25^+ Foxp3^+/CD4^+ 

分 类 号：R735.2[医药卫生—肿瘤]