加速康复外科在完全腹腔镜胃癌根治术中的应用

目的探讨加速康复外科对行完全腹腔镜胃癌根治术患者的免疫功能和术后恢复的影响。方法将行完全腹腔镜胃癌根治术的患者随机分为加速康复组(enhanced recovery after surgery,ERAS组)和对照组,比较两组患者术后各时段血液中CD4^+、CD8^+、CD4^+CD25^+、血清CRP水平、术后恢复情况以及并发症发生情况。结果术后第1天,两组CD4^+、CD8^+、CD4^+、CD25^+水平均较术前降低,差异有统计学意义(t=9.070、7.297、5.830、12.870、3.529、10.547,均P<0.05),两组CD4^+水平差异无统计学意义(t=0.957,p>0.05),ERAS组CD8^+、CD4^+CD25^+水平高于对照组(t=2.163、2.203,P<0.05)。术后第3天,ERAS组CD4^+CD25^+水平与术前差异无统计学意义(t=1.062,P>0.05),两组其余指标升高但仍低于术前水平(t=3.322、5.015、3.418、9.912,均P<0.05);ERAS组CD/、CD8+、CD4+CDM+水平均高于对照组(t=2.804、2.040、2.210,均P<0.05)。术后第5天,两组CD4^+、CD4^+CD25^+和ERAS组CD8^+恢复至术前水平,而对照组CD8^+仍低于术前水平(t=6.862,P<0.05)。术后第1、3、5天,两组血清CRP均较术前升髙,差异均有统计学意义(t=-13.338、-13.715、-11.319、-12.286、-13.182、-15.076,均P<0.05),且ERAS组升高水平均低于对照组,差异均有统计学意义(t=-3.246、-2.100、-2.211,均P<0.05)。ERAS组肛门排气、排便、下床活动时间、经口进食时间以及术后住院时间均短于对照组(2.8±1.0)d比(3.9±0.9)d,t=-5.974;(3.8±0.9)d比(4.3±1.0)d,t=-2.700;(19.1±4.0)h比(35.9±6.6)h,t=-16.045;(9.9±1.6)d比(11.5±2.0)d,t=-4.479,均P<0.05].结论加速康复外科应用于完全腹腔镜胃癌根治术患者的围术期能够有效减少对细胞免疫系统的应激,减轻机体炎症反应,更快地恢复术后胃肠道功能。

Enhanced recovery after surgery in total laparoscopic radical gastrectomy

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on immune function and postoperative recovery in gastric cancer patients undergoing total laparoscopic radical gastrectomy.Methods Patients were randomly divided into ERAS group and control group.Blood CD4^+,CD8^+,CD4^+CD25^+,C-reactive protein,postoperative recovery and complications were compared between the two groups.Results On day1,CD4^+,CD8^+,CD4^+CD25^+in the two groups were significantly lower than those before surgery(t=9.070,7.297,5.830,12.870,3.529,10.547,all P<0.05).The ERAS group had higher CD8^+,CD4^+CD^25+levels than the control group(t=2.163,2.203,P<0.05).On day3,CD4^+CD25^+in ERAS group was not different from that before surgery(t=1.062,P>0.05)while the other indexes in the two groups raised but still were lower than preoperative level(t=3.322,5.015,3.418,9.912,all P<0.05);CD4^+,CD8^+,CD4^+CD^+in ERAS group were higher than control group(t=2.804,2.040,2.210,all P<0.05).On day5,CD4^+,CD4^+CD25^+in the two groups and CD8^+in ERAS group returned to the preoperative level,while CD8^+of the control group was still lower than the preoperative level (t =6.862, P<0.05). On day 1 ,3 and 5, the C-reactive protein levels of the two groups were higher than those before surgery (t =-13.338,-13.715,-11.319,-12.286,-13.182,-15.076, all P<0.05) , and ERAS group were lower than the control group (t =-3.246,-2.100,-2.211,all P<0.05) . There was no mortality in neither groups. The time of passage gas by anus, defecation, getting out of bed, oral feeding, and postoperative hospital stay in the ERAS group were less than those in the control group (2.8±1.0)dvs (3.9±0.9)d, t= -5.974;(3. 8 ± 0.9)d.vs (4.3±1.0)d,- 2.700;(19.1±4.0)h vs.(35.9 ±6.6) h,t=- 16.045;(9.9 ± 1.6)d vs.(11.5 ±2.0) d, t=-4. 479,all P<0.05]. Conclusions ERAS in the perioperative period of patients with total laparoscopic radical gastrectomy mitigates the stress on the cellular immune system, reduces inflammatory response, and help fast recover the postoperative gastrointestinal function.