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中华普通外科学文献(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 390 -393. doi: 10.3877/cma.j.issn.1674-0793.2017.06.007

所属专题: 文献

论著

快速康复外科对中老年直肠癌患者腹腔镜保肛术后炎性反应及免疫功能的影响
李世红1, 刘展1,(), 张抒1, 刘雁军1, 李云涛1, 侯康1, 罗丹1, 张元川1, 黄德全1, 任海亮1, 古建辉1, 龙飞伍1   
  1. 1. 610031 成都市第三人民医院 西南交通大学附属医院胃肠外科
  • 收稿日期:2017-07-04 出版日期:2017-12-01
  • 通信作者: 刘展
  • 基金资助:
    四川省卫计委科研课题资助项目(130420)

Effect of fast track surgery on inflammatory response and immune function in laparoscopic surgery for middle aged and elderly patients with rectal cancer

Shihong Li1, Zhan Liu1,(), Shu Zhang1, Yanjun Liu1, Yuntao Li1, Kang Hou1, Dan Luo1, Yuanchuan Zhang1, Dequan Huang1, Hailiang Ren1, Jianhui Gu1, Feiwu Long1   

  1. 1. Department of Gastrointestinal Surgery, the Affiliated Hospital of Southwest Jiaotong University, the Third People’s Hospital of Chengdu, Chengdu 610031, China
  • Received:2017-07-04 Published:2017-12-01
  • Corresponding author: Zhan Liu
  • About author:
    Corresponding author: Liu Zhan, Email:
引用本文:

李世红, 刘展, 张抒, 刘雁军, 李云涛, 侯康, 罗丹, 张元川, 黄德全, 任海亮, 古建辉, 龙飞伍. 快速康复外科对中老年直肠癌患者腹腔镜保肛术后炎性反应及免疫功能的影响[J/OL]. 中华普通外科学文献(电子版), 2017, 11(06): 390-393.

Shihong Li, Zhan Liu, Shu Zhang, Yanjun Liu, Yuntao Li, Kang Hou, Dan Luo, Yuanchuan Zhang, Dequan Huang, Hailiang Ren, Jianhui Gu, Feiwu Long. Effect of fast track surgery on inflammatory response and immune function in laparoscopic surgery for middle aged and elderly patients with rectal cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(06): 390-393.

目的

探讨快速康复外科(FTS)在中老年腹腔镜直肠癌保肛手术后炎性反应及免疫功能情况。

方法

选取成都市第三人民医院2014年1月至2015年1月间行腹腔镜根治性直肠癌切除且保肛未行造瘘的患者为研究对象,随机分为FTS组(23例)和常规组(25例)。观察比较两组患者手术时间、术中出血量、术后首次肛门排气时间和术后平均住院时间、并发症发生情况,术前1 d和术后1、3、7 d时静脉采血检测CRP、CD4、CD8、CD4/CD8、IL-6水平。

结果

2组手术时间、术中出血量、术后并发症发生率差异无统计学意义。FTS组的术后首次肛门排气时间短于常规组[(37±15)h vs(47±18)h,t=2.081,P<0.05],术后平均住院时间更短[(185±13)h vs (198±25)h,t=2.23,P<0.05]。术后24 h及术后72 h的CRP水平,术后72 h及术后7 d时的CD4、IL-6水平,术后7 d时的CD8水平,术后24 h及术后7 d时的CD4/CD8水平,2组比较差异均有统计学意义(P<0.05)。FTS组和常规组术后并发症发生率差异无统计学意义(21.7% vs 28.0%,χ2=0.250,P=0.617)。

结论

FTS不会增加中老年直肠癌患者腹腔镜保肛手术并发症,并能够降低及缩短患者炎性反应,减轻炎性损伤,缩短免疫功能紊乱时间。

Objective

To investigate the inflammatory response and immune function of fast track surgery (FTS) in elderly patients after laparoscopic rectal surgery for rectal cancer.

Methods

Between January 2014 and January 2015, rectal cancer patients undergoing laparoscopic radical resection and anus without fistula from the Third People’s Hospital of Chengdu City were selected. They were randomly divided into FTS group (23 cases) and control group (25 cases). The operation time, intraoperative bleeding volume, postoperative anal exhaust time and postoperative hospitalization time, complications, CRP, CD4, CD8, CD4/CD8, IL-6 level between the two groups 1 d preoperatively and postoperative 1, 3, 7 d, were observed and compared.

Results

There was no significant difference between the two groups in the time of operation, the amount of bleeding and the incidence of postoperative complications. The first postoperative anal exhaust time in FTS group was shorter than that in the control group [(37±15) h vs (47±18) h, t=2.081, P<0.05], and the average length of stay was shorter [(185±13) h vs (198±25) h, t=2.23, P<0.05]. After the operation, there was significant difference in the levels of CRP at 24 h and 72 h, CD4 and IL-6 levels at 72 h and 7 d, CD8 level at 7 d, CD4/CD8 levels at 24 h and 7 d between the two groups (P<0.05). No significant difference was found in the incidence of postoperative complications between the FTS group and the control group (21.7% vs 28.0%, χ2=0.25, P=0.617).

Conclusion

Fast track surgery will not increase the complications of laparoscopic anal sphincter preservation surgery in middle-aged and elderly patients with rectal cancer, and can reduce and shorten the inflammatory response, reduce inflammatory damage and shorten the time of immune dysfunction.

表1 2组直肠癌患者手术和住院情况比较(±st检验)
表2 2组直肠癌患者术前1 d、术后24 h静脉采血CRP、CD4、CD8、CD4/CD8、IL-6水平比较
表3 2组直肠癌患者术后3、7 d时静脉血CRP、CD4、CD8、CD4/CD8、IL-6水平
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