结直肠癌病人用加速康复外科理念行腹腔镜手术对机体免疫功能的影响

目的:观察加速康复外科(FTS)联合腹腔镜技术对结直肠癌根治手术病人机体免疫功能的影响。方法:将122例结直肠癌根治术病人随机分成三组,即常规剖腹对照组(Ⅰ组,39例),应用传统围手术期处理行剖腹手术;加速康复剖腹组(Ⅱ组,42例),应用FTS理念行剖腹手术;加速康复腔镜组(Ⅲ组,41例),应用FTS理念行腹腔镜手术。三组分别于术前、术后第3和第7天取外周静脉血,测定C反应蛋白(CRP)、白细胞介素6(IL-6)、免疫球蛋白(IgA、IgM、IgG)以及T细胞亚群(CD3+、CD4+和CD4+/CD8+比值)等。结果:三组病人术后第3和第7天CRP、IL-6较术前均明显升高(P<0.01),与Ⅱ组和Ⅲ组比,Ⅰ组术后第3天、第7天CRP、IL-6升高更明显(P<0.01),与Ⅲ组比,Ⅱ组亦有明显升高(P<0.05)。三组病人免疫球蛋白于术后第3天较术前均明显降低(P<0.05),与Ⅱ、Ⅲ组比,Ⅰ组降低更明显(P<0.05),术后第7天,Ⅱ组和Ⅲ组免疫球蛋白恢复至术前水平,但Ⅰ组仍明显低于术前(P<0.05)。三组病人术后第3天T细胞亚群较术前明显降低(P<0.01),与Ⅱ组和Ⅲ组比,Ⅰ组降低更明显(P<0.05),Ⅱ组和Ⅲ组术后第7天均恢复至术前水平,但Ⅰ组仍明显低于术前(P<0.05)。结论:结直肠癌病人应用FTS理念行腹腔镜手术,可更有效地缓解术后的炎性反应,保护免疫功能,对病人术后的加速恢复起到了积极的作用。

Effect of fast tract surgery on immune function after Laparoscopic colorectal resection

Objective: To investigate the influence of fast tract surgery on the immune function and inflammatory responses after Laparoscopic colorectal resections in cancer patients.Methods: 122 patients were randomized to receive traditional protocol and open surgery(groupⅠ,n=39),fast track protocols and open surgery(group Ⅱ,n=42),fast track surgery and laparoscopic surgery(group Ⅲ,n=41).CRP、IL-6、IgG、IgM、IgA、CD3+、CD4+、CD4+/CD8+were tested before operation and after operation for 3 and 7 days.Results: On the day 3,7 postoperatively,IL-6 and CRP significantly increased as compared to those preoperatively in three groups(P<0.01),but the parameters in group Ⅰwere significantly higher than those in group Ⅱ and Ⅲ(P<0.01),and the parameters in group Ⅱ were significantly higher than those in group Ⅲ(P<0.05).On the day 3 postoperatively,IgG、IgM、IgA significantly decreased as compared with those preoperatively in three groups(P <0.05),and the parameters in group Ⅰ were significantly lower than those in group Ⅱ and Ⅲ(P<0.01).On the day 7,there was no significant difference of IgG、IgM、IgA between before and after operation in groupⅡ and Ⅲ(P>0.05),but the parameters in group Ⅰ were significantly lower than those preoperatively.On day 3 postoperatively,CD3+,CD4+and the ratio of CD4+/CD8+significantly decreased as compared to those preoperatively in three groups(P<0.05),and the parameters in group Ⅰwere significantly lower than those in group Ⅱ and Ⅲ(P<0.01).The levels of CD3+,CD4+ and the ratio of CD4+/CD8+ recovered rapidly in group Ⅱ and Ⅲ on the day 7 postoperatively(P>0.05),but the parameters in group Ⅰ were significantly lower than those preoperatively.Conclusion: Fast track surgery mitigates the immunologic impairment of colorectal cancer patients after laparoscopic colorectal resection,and accelerates postoperative rehabilitation.