腹腔镜辅助胃癌根治术的临床疗效和对患者外周血免疫功能水平的影响

目的 探讨腹腔镜辅助胃癌根治术治疗胃癌的临床疗效以及其对患者外周血细胞因子的影响.方法 对86例进展期胃癌患者临床相关资料进行回顾性分析,根据其治疗方法分为对照组(开腹胃癌根治术,共48例)和腹腔镜组(腹腔镜辅助胃癌根治术,共38例).对2组患者围手术期相关指标和术前1d、术后1d和术后7d外周血细胞免疫功能数据进行整理和分析.结果 腹腔镜组术中出血量显著少于开腹组(P<0.05),手术时间显著长于开腹组(P<0.05),术后肛门排气时间、下床活动时间以及术后住院时间均显著短于开腹组(P<0.05).与手术前比较,2组患者术后第1天和第7天外周血CD3、CD4+以及CD8+均显著下降(P<0.05);而CD4+/CD8+术后第1天与术前比较显著下降,术后第7天与术前比较无统计学差异(P>0.05).术后第7天腹腔镜组各外周血免疫功能指标均高于开腹组(P<0.05).2组患者术后第1天免疫球蛋白水平均显著下降(P<0.05),CRP显著上升(P<0.05);在术后第7天,腹腔镜组CRP与术前比较显著上升(P<0.05),且显著低于开腹组(P<0.05).开腹组患者IgA、IgG、IgM等免疫球蛋白水平与术前比较显著下降(P<0.05),且显著低于腹腔镜组(P<0.05).结论 腹腔镜辅助胃癌根治术能显著提高患者的近期临床治疗效果,提高围手术期患者的外周血免疫功能水平.

Clinical Efficacy of Laparoscopic-assisted D2 Gastrectomy and Its Effect on Peripheral Blood Immune Function Level in Patients with Gastric Cancer

Objective To discuss the clinical efficacy of laparoscopic-assisted D2 gastrectomy and its effect on peripher-al blood immune function level in patients with gastric cancer.Methods Clinical data of 86 patients with advanced gastric cancer were retrospectively analyzed ,they were divided into the control group ( open D2 Gastrectomy,48 cases) and laparoscopic group (laparoscopic-assisted D2 Gastrectomy,38 cases).Perioperative related indicators and 1 d preoperative,1 d and 7 d after surgery peripheral blood cell immune function data of the 2 groups were collected and analyzed.Results The bleeding amount during surgery of the laparoscopic group was significantly less than the laparotomy group (P<0.05);operation time of the laparoscopic group was significantly longer than the laparotomy group (P<0.05);anus exhaust time,postoperative bed activity time and post-operative hospital stay of the laparoscopic group were significantly shorter than the laparotomy group (P<0.05).Compared with before the operation ,1 d and 7 d postoperative peripheral blood CD 3+,CD4+and CD8+of the 2 groups significantly decreased (P<0.05),and CD4+/CD8+1 d preoperative compared with before the operation declined significantly ,7 d preoperative had no significant difference(P<0.05).7 d after operation,peripheral immune function index of the laparoscopic group were higher than the laparotomy group (P <0.05).Postoperative 1 d immunoglobulin levels of the 2 groups significantly decreased (P <0.05),the CRP significantly increased (P<0.05);7 d after surgery,CRP in the laparoscopic group compared with before the op-eration significantly increased(P<0.05),and was significantly lower than the laparotomy group (P<0.05),IgA,IgG,IgM im-mune globulin level of the laparotomy group compared with before the operation significantly decreased (P<0.05),and were sig-nificantly lower than the laparoscopic group (P<0.05).Conclusion Laparoscopic assisted D2 gastrectomy can significantly im-prove recent clinical curative effect ,and improve the immune function of peripheral blood.