摘要
目的探讨老年中晚期食管癌伴吞咽困难者行胃造瘘术对患者免疫功能、应激反应及营养状况的影响。方法回顾性分析2018年2月至2020年3月河北省退役军人总医院收治的84例老年中晚期食管癌伴吞咽困难患者的临床诊治资料。根据患者营养提供方式的不同分组,其中33例行支架置入术者作为A组,51例行胃造瘘术者作为B组。治疗前及术后1周比较两组患者外周血中免疫细胞转录因子表达量、血清炎症应激标志物水平、营养指标及并发症发生情况。结果术后1周,两组患者的T-bet表达量均较术前明显升高,且B组患者为(1.47±0.25),明显高于A组的(1.21±0.22),差异均有统计学意义(P<0.05);术后1周,两组患者GATA3和Foxp3表达量均明显下降,但B组患者分别为(0.73±0.08)、(0.54±0.11),明显低于A组的(0.92±0.09)、(0.81±0.15),差异均有统计学意义(P<0.05)。术后1周,两组患者的去甲肾上腺素、皮质醇及C反应蛋白水平均明显升高,且B组患者分别为(56.02±14.96)ng/mL、(193.05±37.28)ng/mL、(7.33±1.88)μg/mL,明显低于低于A组的(71.93±13.27)ng/mL、(231.72±32.08)ng/mL、(9.14±2.06)ng/mL,差异均有统计学意义(P<0.05);术后1周,两组患者的白蛋白、前蛋白及血红蛋白水平均较术前下降,且B组患者分别为(33.95±2.95)g/L、(0.24±0.04)g/L、(115.81±8.75)g/L,明显高于A组的(30.16±3.04)g/L、(0.21±0.06)g/L、(109.42±9.83)g/L,差异均有统计学意义(P<0.05);A组患者的术后并发症发生率为21.21%,明显高于B组的5.88%,差异有统计学意义(P<0.05)。结论胃造瘘术治疗老年中晚期食管癌伴吞咽困难患者能明显改善患者免疫功能水平,其能显著缓解患者应激水平,改善患者营养状态,同时还能明显缓解患者并发症,安全可靠。
Objective To explore the effects of gastrostomy on immune function,stress response,and nutritional status in elderly patients with advanced esophageal cancer and dysphagia.Methods A retrospective analysis was conducted on the clinical diagnosis and treatment data of 84 elderly patients with advanced esophageal cancer and dysphagia treated at Hebei Provincial Veterans General Hospital from February 2018 to March 2020.According to the different ways of providing nutrition for patients,33 patients who underwent stent placement were enrolled as group A,and 51 patients who underwent gastrostomy were enrolled as group B.The expression levels of immune cell transcription factors,serum levels of inflammatory stress markers,nutritional indicators,and incidence of complications in the peripheral blood were compared between the two groups.Results At 1 week after surgery,T-bet expression was significantly increased compared with that before surgery,and the level in group B was 1.47±0.25,significantly higher than 1.21±0.22 in group A;the differences were statistically significant(P<0.05).GATA 3 and Foxp 3 expression was significantly reduced,and the levels were 0.73±0.08 and 0.54±0.11 in group B,significantly lower than 0.92±0.09 and 0.81±0.15 in group A,with statistically significant differences(P<0.05).One week after surgery,the levels of noradrenaline,cortisol,and C-reactive protein were significantly increased in both groups,and the levels in group B were(56.02±14.96)ng/mL,(193.05±37.28)ng/mL,(7.33±1.88)μg/mL,significantly lower than(71.93±13.27)ng/mL,(231.72±32.08)ng/mL,(9.14±2.06)ng/mL in group A,with statistically significant differences(P<0.05).One week after surgery,albumin,proprotein,and hemoglobin levels in both groups decreased compared with the preoperative levels,and the levels in group B were(33.95±2.95)g/L,(0.24±0.04)g/L,(115.81±8.75)g/L,significantly higher than(30.16±3.04)g/L,(0.21±0.06)g/L,(109.42±9.83)g/L in group A,with statistically significant differences(P<0.05).The postoperative com
作者
王玉强
张永红
齐增平
乔钦增
路大鹏
赵卫林
路洪超
WANG Yu-qiang;ZHANG Yong-hong;QI Zeng-ping;QIAO Qin-zeng;LU Da-peng;ZHAO Wei-lin;LU Hong-chao(Department of Oncology,Medical Imaging Department,Xingtai 054000,Hebei,CHINA;Department of Oncology,Oncology Surgery Department,Xingtai 054000,Hebei,CHINA;Department of Oncology,Hebei Provincial Veterans General Hospital,Xingtai 054000,Hebei,CHINA)
出处
《海南医学》
CAS
2024年第4期507-511,共5页
Hainan Medical Journal
基金
河北省科技计划项目(编号:162777275)。
关键词
老年
中晚期食管癌
吞咽困难
胃造瘘术
支架置入术
免疫功能
应激反应
营养状况
Elderly
Advanced esophageal cancer
Dysphagia
Gastrostomy
Stent placement
Immune function
Stress response
Nutritional status
