两种切除术对胃癌病人术后康复及外周血细胞表面PD-L1表达的影响  

Influence of two kinds of gastrectomies on postoperative rehabilitation and expression of PD-L1 on peripheral blood cells of gastric cancer patients

作　　者：李翔 齐涵 李玉文[3] 王刚[1] 陆峰 邱磊[1] 杨修伟 苗永昌[1] LI Xiang;QI Han;LI Yuwen(Department of General Surgery,Lianyungang Second Peoples Hospital Jiangsu,Lianyungang 222000,China;不详)

机构地区：[1]江苏省连云港市第二人民医院普外科,222000 [2]江苏省连云港市第二人民医院急诊外科,222000 [3]辽宁省大连医科大学附属第一医院普外科

出　　处：《临床外科杂志》2021年第8期754-756,共3页Journal of Clinical Surgery

基　　金：连云港市中青年人才成长基金资助项目(TQ201708)。

摘　　要：目的对比完全腹腔镜根治性全胃切除术(TLTG)与腹腔镜辅助根治性全胃切除术(LATG)对胃癌病人术后康复、外周血细胞表面程序性死亡蛋白配体1(PD-L1)表达的影响。方法拟行全胃切除术的病人108例,随机分为TLTG组和LATG组,每组各54例。比较两组术中情况、术后康复,手术前后外周血T淋巴细胞亚群及不同分化病人细胞表面程序性死亡蛋白1(PD-1)及PD-L1。结果两组淋巴结清扫数、术中出血量、食管空肠吻合、总手术时间、下地活动时间、CD8+、细胞表面PD-1比较差异无统计意义(P>0.05)。与LATG组比较,TLTG组切口长度、镇痛时间、排气时间、进流(软)食时间、术后住院时间,总的、高、中低分化细胞表面PD-L1表达,并发症减少,T淋巴细胞亚群增高,差异有统计学意义(P<0.05)。结论与LATG比较比,TLTG治疗胃癌疼痛小、康复快,T淋巴细胞亚群及PD-L1表达低,应激反应或免疫抑制轻。Objective To compare the influence of totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)on postoperative rehabilitation and expression of programmed cell death-Ligand 1(PD-L1)on peripheral blood cells for patients with gastric cancer.Methods 108 patients underwent laparoscopic radical gastrectomy were randomly divided into the TLTG group and LATG group,54 cases/group.The intraoperative conditions,postoperative rehabilitation and complications were compared in 2 groups.Peripheral blood T lymphocyte subsets and cell surface programmed cell death-1(PD-1)/PD-L1 were measured before and after surgery.Results Both groups had completed the operation.There were no statistically significant differences in the number of lymph node dissections,intraoperative blood loss,esophageal jejunal anastomosis,total surgery time,ground activities,CD8+,and cell surface PD-1 in 2 groups(P>0.05).Compared with the LATG group,the incision length,analgesia,first exhaust,inflow(soft)food,postoperative hospital stay,total,high and moderately poorly differentiated cell surface PD-L1 expression and complications had induced,T lymphocyte subsets had increased(P<0.05).Conclusion Compared with LATG,TLTG has the advantages of minimal invasiveness,less postoperative pain and faster recovery in the treatment of gastric cancer,lower T lymphocyte subsets and PD-L1,and less stress response or immunosuppression.

关 键 词：胃癌根治性切除术 腹腔镜 细胞表面程序性死亡蛋白配体1 

分 类 号：R735.2[医药卫生—肿瘤]