加速康复外科联合腹腔镜手术对胃癌患者术后肠道生物屏障稳定性的影响研究

目的探讨加速康复外科(ERAS)联合腹腔镜手术对于胃癌患者术后肠道生物屏障稳定性、免疫功能及应激反应的临床研究。 方法回顾性分析2016年1月至2018年6月期间收治的胃癌患者88例资料，患者均进行腹腔镜胃癌根治术治疗，按照治疗干预方案不同分为ERAS组和传统组。ERAS组42例患者采用ERAS干预，传统组46例患者给予常规治疗。采用SPSS 20.0进行数据分析，术后各临床指标、肠道菌属数目等计量资料采用 ±s表示，独立t检验；术后并发症、病理分级等计数资料采用χ²检验；P<0.05表示差异有统计学意义。 结果ERAS组患者术后肛门通气时间、发热时间、下床活动时间、首次进食时间、住院时间显著短于传统组(P<0.05)；术后ERAS组患者粪便各菌属数量明显多于传统组(P<0.05)；术后3 d ERAS组患者血清CD4^＋、CD4^＋/CD8^＋ 、IgG、IgM、IgA明显优于传统组(P<0.05)；术后ERAS组患者应激反应较传统组低，血清IL－6、CRP、TNF－α水平明显低于对照组，差异均有统计学意义(P<0.05)。 结论加速康复外科联合腹腔镜手术对于胃癌患者术后肠道生物屏障、术后免疫功能、应激反应等具有重大意义，且可有效促进患者术后康复，值得临床推广。

Impact of enhanced recovery after surgery combined with laparoscopic surgery on intestinal biological barrier stability of patients with gastric cancer

ObjectiveTo investigate the impact of enhanced recovery after surgery(ERAS) combined with laparoscopic surgery on intestinal biological barrier stability, immune function and stress response of patients with gastric cancer. MethodsFrom January 2016 to June 2018, clinical data of 88 patients with gastric cancer were retrospectively analyzed. All of 88 patients received laparoscopic radical gastrectomy. According to the intervention scheme, 88 paients were divided into ERAS group (n=42) and traditional group (n=46). Spss20.0 software was used for data analysis.Measurement data such asnumber of intestinal bacteriawere presented as mean+ standard deviation and were examined by using t test. Postoperative complicationrate, pathological grade and other count data were expressed as %, and were compared with χ² test. P<0.05 was considered as significant difference. ResultsTime of bowel movement, fever, ambulation, recovery of oral nutrition intake and time of hospitalization in ERAS group were significantly shorter than those in traditional group respectively (P<0.05). Number of fecal bacteria in ERAS group was significantly higher than that in traditional group (P<0.05). Peripheral CD4⁺ T cells, CD4/CD8⁺ T cells and serum IgG, IgM, IgA in ERAS group were significantly better than those in traditional group 3 days after operation (P<0.05). The stress response in ERAS group was lower than that in traditional group, and the serum IL-6, CRP, TNF-α level were significantly lower than those in control group respectively (P<0.05). ConclusionERAS combined with laparoscopic surgery is of great significance for postoperative intestinal biological barrier, postoperative immune function and stress response in patients with gastric cancer.