摘要
背景与目的:加速康复外科(ERAS)对外科手术患者的益处已被证实,但是,ERAS对胃癌根治术患者细胞免疫功能及应激反应在分子水平上的影响仍鲜见报道。本研究探讨ERAS理念和措施对腹腔镜胃癌根治术患者肿瘤细胞免疫、炎症因子及应激激素的影响。方法:纳入2018年1月—2020年12月行腹腔镜胃癌根治术胃癌患者90例,分为ERAS组(43例)和对照组(47例)。ERAS组患者接受ERAS理念行围手术期管理,对照组患者行传统围手术期管理。比较两组在一般资料(性别、年龄、BMI、ASA体格情况评估分级、TNM分期、肿瘤大小),手术相关指标(手术方式、吻合方式、手术时间、术中出血量、淋巴结清扫数)及术后指标(术后下床活动时间、术后肛门首次排气时间、住院时间及术后并发症)的差异。比较两组患者术后1 d及术后7 d两组患者外周血中肿瘤正向免疫调控细胞(CD3+CD4+T细胞、CD3+CD8+T细胞、CD16+CD56+NK细胞);负向免疫调控细胞[中性粒细胞型骨髓源性抑制细胞(G-MDSC)、单核细胞型骨髓源性抑制细胞(M-MDSC)、T-调节细胞(Treg)]及调节性B细胞(Breg)细胞数量百分比,以及两组患者术前及术后24 h应激指标皮质醇(COR)、促肾上腺皮质激素(ACTH)、肾上腺素(EPI)及炎症因子C反应蛋白(CRP)、白细胞介素6(IL-6)水平的差异。结果:ERAS组与对照组在性别、年龄、BMI、ASA分级、TNM分期、肿瘤大小、手术方式、吻合方式、手术时间、术中出血量及淋巴结清扫数方面差异均无统计学意义(均P>0.05)。ERAS组术后下床活动时间和术后肛门首次排气时间均早于对照组(25.01 h vs.37.01 h,P=0.000;74.51 h vs.135.31 h,P=0.000),ERAS组住院时间短于对照组(7.01 d vs.9.81 d,P=0.000)。ERAS组总术后并发症率小于对照组(9.3%vs.19.1%,P=0.027)。在术后1 d及7 d,ERAS组CD3+CD4+T细胞、CD3+CD8+T细胞、CD16+CD56+NK细胞所占百分比高于对照组,而G-MDSC、M-MDSC和Treg细胞及Br
Background and Aims:It has been proven that enhanced recovery after surgery(ERAS)offers advantages for patients undergoing surgery.However,the effects of ERAS on cellular immune function and stress response at the molecular level in patients undergoing radical gastrectomy are still rarely reported.Therefore,this study was conducted to investigated the effects of ERAS concept and protocol on tumor cell immunity,inflammatory factors and stress hormones in patients undergoing laparoscopic radical gastrectomy.Methods:From January 2018 to December 2020,90 patients with gastric cancer undergoing laparoscopic radical gastrectomy were selected and divided into ERAS group(43 cases)and control group(47 cases).The patients in ERAS group received ERAS perioperative management,while those in control group received the traditional perioperative management.The general clinical data(sex,age,BMI,ASA grade,TNM stage,and tumor size),surgery related variables(surgical procedure,anastomosis method,operative time,intraoperative blood loss,and lymph node dissection),and postoperative variables(time to postoperative ambulation,time to postoperative anal gas passage,length of hospitalization,and postoperative complications)were compared between the two groups.The percentages of positive immunoregulatory cells(CD3+CD4+T cells,CD3+CD8+T cells and CD16+CD56+NK cells),negative immunoregulatory cells[granulocytic myeloid-derived suppressor cells(G-MDSC),monocytic myeloid-derived suppressor cells(M-MDSC)and regulatory T cells(Treg)]and regulatory B cells(Breg)in the peripheral blood at 1 and 7 d after operation,as well as the levels of stress response indexes that included cortisol(COR),adrenocorticotropic hormone(ACTH),epinephrine(EPI)and C-reactive protein(CRP)and the inflammatory factors that included the interleukin-6(IL-6)before and 24 h after operation were compared between the two groups.Results:There was no significant difference in terms of sex,age,BMI,ASA grade,TNM stage,tumor size,surgical procedure,anastomosis method,operative time
作者
戴春
谭明
丁永斌
华召来
莫广沛
史君成
侯飞城
DAI Chun;TAN Ming;DING Yongbin;HUA Shaolai;MO Guangpei;SHI Juncheng;HOU Feicheng(Department of General Surgery,Yangzhong People's Hospital,Yangzhong,Jiangsu 212200,China;Department of General Surgery,Jiangsu Provincial People's Hospital,Nanjing 210029,China;Cancer Research Institute of Yangzhong City,Yangzhong,Jiangsu 212200,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2021年第10期1160-1167,共8页
China Journal of General Surgery
基金
江苏省镇江市重点研发计划资助项目(SH2019070)
江苏省卫生厅医改试点单位科研项目(YG201410)。
关键词
胃肿瘤
胃切除术
腹腔镜
快速康复外科
免疫
细胞
炎症
应激
生理学
Stomach Neoplasms
Gastrectomy
Laparoscopes
Enhanced Recovery After Surgery
Immunity,Cellular
Inflammatory
Stress,Physiological
