CAJ | 학술논문

目的探讨术中腹腔灌注化疗(HIIC)及术后营养支持对进展期胃癌患者肠黏膜通透性和免疫功能的影响.方法将2007年12月至2008年12月间江苏省肿瘤医院胃肿瘤诊疗中心收治的65例进展期胃癌,患者按随机数字表法随机分为EN组(术后早期肠内营养,20例)、HIIC加EN组(HIIC加术后早期肠内营养,22例)和HIIC加PN组(HIIC加术后肠外营养,23例).分别于术前1d及术后3、7、12d,应用高效液相色谱检测其尿L/M比值,应用流式细胞术检测外周血CD4+、CD8+和自然杀伤(NK)细胞比例及CD4/CD8细胞比值.结果术前1d,EN组、HIIC加EN组和HIIC加PN组患者L/M值分别为0.0280±0.0183、0.0305±0.0208和0.0298±0.0229;术后3d,3组患者L/M值均明显升高(0.1235±0.0611、0.1648±0.0571和0.1702±0.0628),与术前比较,差异均有统计学意义(P＜0.05),其中HIIC加EN组和HIIC加PN组明显高于EN组(P＜0.05)；之后,3组L/M值均开始回落,至术后12 d,EN组(0.0278±0.0217)和HIIC加EN组(0.0336±0.0235) L/M值已回落至术前水平(均P＞0.05),而HIIC加PN组(0.0616±0.0430)仍明显高于术前水平及其他两组(均P＜0.05).与术前1d相比,术后12 d EN组和HIIC加EN组患者CD4+细胞比例、CD4/CD8比值均明显升高(均P＜0.05)；且HIIC加EN组和HIIC加PN组CD4+细胞比例显著低于EN组(均P＜0.05).结论 HIIC会加重进展期胃癌患者术后肠黏膜通透性的损伤,并一定程度地抑制细胞免疫功能;而术后早期肠内营养支持能够改善HIIC引起的肠黏膜通透性损害.
목적 탐토술중복강관주화료(HIIC)급술후영양지지대진전기위암환자장점막통투성화면역공능적영향.방법 장2007년12월지2008년12월간강소성종류의원위종류진료중심수치적65례진전기위암,환자안수궤수자표법수궤분위EN조(술후조기장내영양,20례)、HIIC가EN조(HIIC가술후조기장내영양,22례)화HIIC가PN조(HIIC가술후장외영양,23례).분별우술전1d급술후3、7、12d,응용고효액상색보검측기뇨L/M비치,응용류식세포술검측외주혈CD4+、CD8+화자연살상(NK)세포비례급CD4/CD8세포비치.결과 술전1d,EN조、HIIC가EN조화HIIC가PN조환자L/M치분별위0.0280±0.0183、0.0305±0.0208화0.0298±0.0229;술후3d,3조환자L/M치균명현승고(0.1235±0.0611、0.1648±0.0571화0.1702±0.0628),여술전비교,차이균유통계학의의(P＜0.05),기중HIIC가EN조화HIIC가PN조명현고우EN조(P＜0.05)；지후,3조L/M치균개시회락,지술후12 d,EN조(0.0278±0.0217)화HIIC가EN조(0.0336±0.0235) L/M치이회락지술전수평(균P＞0.05),이HIIC가PN조(0.0616±0.0430)잉명현고우술전수평급기타량조(균P＜0.05).여술전1d상비,술후12 d EN조화HIIC가EN조환자CD4+세포비례、CD4/CD8비치균명현승고(균P＜0.05)；차HIIC가EN조화HIIC가PN조CD4+세포비례현저저우EN조(균P＜0.05).결론 HIIC회가중진전기위암환자술후장점막통투성적손상,병일정정도지억제세포면역공능;이술후조기장내영양지지능구개선HIIC인기적장점막통투성손해.
Objective To investigate the effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) and postoperative nutritional support on the intestinal permeability and the cellular immunity function in patients with advanced gastric cancer.Methods All the patients diagnosed as advanced gastric cancer in the Gastric Tumor Diagnosis and Treatment Center of Jiangsu Cancer Hospital were randomly divided into three groups using random digit table:(1)EN group treated with enteral nutrition during postoperative period; (2)HIIC +EN group treated with HIIC combined with postoperative enteral nutrition; (3)HIIC +PN group treated with HIIC combined with postoperative parenteral nutrition.Index of lactulose/mannitol(L/M) ratio was used to evaluate the permeability of intestinal mucosa.The percentage of CD4+,CD8+ and NK cell,the ratio of CD4/CD8 T cell in peripheral blood were tested by flow cytometry.The time points of these measurements were the day before surgery,postoperative days (POD) 3,7,and 12.Results Compared with the day before surgery(POD-1),the ratio of L/M on POD+3 increased significantly in all the three groups(0.1235±0.0611 vs.0.0280±0.0183,0.1648±0.0571 vs.0.0305±0.0208,0.1702±0.0628 vs.0.0298±0.0229)(P＜0.05) and then decreased gradually.The L/M ratio of EN (0.0278±0.0217) and HIIC+EN (0.0336±0.0235) groups recovered to the baseline on POD+12,however HIIC+PN group still had elevated L/M ratio (0.0616±0.0430).The percentage of CD4+T cell and the ratio of CD4/CD8 in HIIC+EN group and HIIC+PN group were significantly lower than those in EN group (P=0.033,P=0.002,respectively).Companed with the POD-1,the percentage of CD4+T cell and the ratio of CD4/CD8 in HIIC+EN group and EN group on POD+12 were increased significantly (P＜0.05).Conclusions HIIC may cause significant increase in intestinal permeability and inhibit cellular immunity in patients undergoing radical resection for advanced gastric cancer.Mucosal penneability can be reversed by enteral nutrition.