摘要
目的研究腹腔镜在老年人结直肠加速康复外科中的应用,评判其价值。方法将50例结直肠癌的老年患者随机分为两组,Ⅰ组为加速康复外科(ERAS)开腹组(n=25),Ⅱ组为ERAS腹腔镜组(n=25);分别记录两组患者围手术期的相关指标。结果在肠道通气时间及耐受半流质饮食时间上,Ⅱ组比Ⅰ组恢复的快。术后第3天和第7天Ⅰ组患者的CRP与IL-6水平比Ⅱ组升高更明显(t=4.133,3.915,2.138,5.298;均P <0.05)。术后第3天,Ⅰ组患者的免疫球蛋白IgM含量下降比Ⅱ组更明显(t=2.163,P <0.05);术后第7天,Ⅰ组的IgM、IgA低于术前水平(t=2.876,2.855;均P <0.01),Ⅱ组与手术前相比差异无统计学意义。T细胞亚群均较术前降低,Ⅰ组CD4^+下降比Ⅱ组更明显(t=4.075,P <0.05)。4种内脏蛋白水平较术前均明显减低,Ⅰ组的TRF水平低于Ⅱ组(t=5.547,2.357;均P <0.05);术后第7天,Ⅰ组的四种内脏蛋白相比于术后第3天有所升高,Ⅱ组PRE、TRF的含量与术前相比差异无统计学意义(t=1.625,0.816;均P> 0.05)。结论老年结直肠癌患者在ERAS理念下行腹腔镜手术,加速了老年患者的术后康复进程,减少了手术创伤对机体免疫功能的损害,减少了营养损耗,是可行的方式。
Objective To study the application of laparoscopy in the elderly colorectal enhanced recovery after surgery, and to evaluate its value. Methods Fifty elderly patients with colorectal cancer were randomly divided into two groups: enhanced recovery after surgery protocols and open surgery (groupⅠ: n=25), enhanced recovery after surgery protocols and laparoscopic surgery (group Ⅱ: n=25). Their perioperative related indicators were recorded and analyzed. Results In the time to anal exhaust and the tolerant time for semi-fluid diet intake, group Ⅱ recovered faster than group I. On the third and the seventh day after operation, the levels of CRP and IL-6 in group I was more significant than those in group Ⅱ(t=4.133, 3.915, 2.138, 5.298;all P < 0.05). On the third day after operation, the levels of immunoglobulin IgM content in group I was more obvious than that in group Ⅱ(t=2.163, P< 0.05). The T cell subsets were lower than those before operation, the decrease of CD4+ in groupⅠwas more obvious than that in group Ⅱ(t=4.075, P < 0.05). The levels of four kinds of visceral proteins were significantly lower than those before operation, and the level of TRF in group I was lower than that in group Ⅰ(t=5.547, 2.357;all P < 0.05);on the seventh day after operation, the four visceral proteins in group I increased compared with the third day after operation, and the contents of PRE and TRF in group Ⅱ were not significantly different from those before operation (t=1.625, 0.816;all P > 0.05). Conclusion Laparoscopic surgery in elderly patients with colorectal cancer under the concept of ERAS accelerated the recovery process of elderly patients, reduced the damage of surgical trauma to the body′s immune function, and reduced the nutritional loss.
作者
迟洪辉
邱志刚
位俊慧
卢云
孙振青
Chi Honghui;Qiu Zhigang;Wei Junhui;Lu Yun;Sun Zhenqing(Department of Gastrointestinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastrointestinal Surgery,Binzhou City Center Hospital,Binzhou 251700,China)
出处
《中华结直肠疾病电子杂志》
2019年第2期145-149,共5页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
青岛市自主创新重大专项胃肠外科子项目(No.14-6-1-zdzx-7)
关键词
结直肠肿瘤
腹腔镜
加速康复外科
老年
应激和免疫功能
营养状态
Colorectal neoplasms
Laparoscopes
Enhanced recovery after surgery
Aged
Stress and immune function
Nutritional status
