摘要
目的观察加速康复外科（fast track surgery，FTS）概念指导下腹腔镜辅助远端胃癌根治术（laparoscopy assisted distal gastrectomy，LADG）对胃癌患者炎症应激反应和体液免疫功能的影响。方法选择烟台毓璜顶医院2009年1月至2010年11月期间入院接受手术治疗的82例远端胃癌患者，随机分为4组：FTS＋LADG组（19例）、LADG组（22例）、FTS＋开腹远端胃癌根治术（open distal gastrectomy，ODG）组（21例）和ODG组（20例），检测4组患者的血清CRP、C3、C4、IgG、IgA、IgM并进行对比分析。结果ODG组血清CRP术后水平和变化幅度明显高于其他3组（均P〈0．01、均P〈0．05），其中FFS＋LADG组在术后变化幅度低于FTS＋ODG组（均P〈0．05）。FTS＋LADG组血清c3、c4水平高于ODG组（P〈0．05、P〈0．05）。血清c3水平变化幅度在其他3组明显低于ODG组（均P〈0．05）。血清c4水平变化幅度以FTS＋LADG组最低（P〈0．05），其次为LADG组（P〈0．01），ODG组最高（P〈0．05）。术后其他3组血清IgG、IgA水平均高于ODG组（均P〈0．01）。FTS＋LADG组的血清IgM水平变化幅度在第1～4天低于ODG组（P〈0．01）。结论FTS的围手术期处理和腹腔镜技术均可以减轻围手术期炎症应激反应，二者联合应用有一定的优势。
Objective TO observe the effect on humoral immune function and stress reaction of fast track surgery （FTS） combined with laparoscopy assisted distal gastrectomy （LADG） for gastric cancer patients. Methods Eighty-two patients were admitted to Yantai Yuhuangding Hospital with distal gastric cancer from January 2009 to November 2010, patients were randomly divided into four groups ： （ 1 ） FTS ＋ LADG （n=19）, （2） LADG （n=22）, （3） FTS＋open distal gastrectomy （ODG） （n=21） and （4） ODG （ n = 20）. CRP, C3, C4,IgG,IgA,IgM were determined and compared between the 4 groups. Results CRP levels was the highest in ODG group among the 4 groups after surgery （ all P 〈0. 01 ）. That in FTS ＋ LADG group changed less than that in FTS ＋ ODG group （ P 〈 0. 05 ）. The levels of C3 and C4 were the highest in FTS ＋ LADG group （ P 〈 0.05 ）. C3 changed most drastically in ODG group （ P 〈 0. 05 ）. C4 was the lowest in FTS ＋ LADG group secondary in order to that in FTS ＋ LADG group, FTS ＋ ODG group and ODG group （P 〈 0. 05; P 〈 O. 01, P 〈 0. O1 ）. IgG and IgA levels was the lowest in ODG group （all P 〈 0. 01 ）. IgM changed less in FTS ＋ LADG group than in ODG group （ P 〈 0. 01 ）. Conclusions FTS management and laparoscopic surgery can both decrease the inflammatory response and preserve the postoperative early humoral immune function. Combination of FTS and LADG contributes further though not statistically significant in reducing postoperative immune responses.
出处
《中华普通外科杂志》
CSCD
北大核心
2013年第7期529-533,共5页
Chinese Journal of General Surgery
关键词
胃肿瘤
腹腔镜
C反应蛋白质
体液免疫
加速康复外科
Stomach neoplasmas
Laparoscopes
C-reactive proteins
Humoral immune
Fast track surgery
