CAJ | 학술논문

快速康复外科对老年结直肠癌患者免疫功能及炎性反应的影响
쾌속강복외과대노년결직장암환자면역공능급염성반응적영향
Effect of fast tract surgery on immune and inflammatory reaction of elder patients with colorectal cancer

万方数据

中华胃肠外科杂志中華胃腸外科雜誌 중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年 12期 1223-1226 ,共4页

马磊%王立凤%丁克%刘广余%张丹丹

마뢰%왕립봉%정극%류엄여%장단단

结直肠肿瘤%老年%快速康复外科%炎性反应%免疫功能結直腸腫瘤%老年%快速康複外科%炎性反應%免疫功能
결직장종류%노년%쾌속강복외과%염성반응%면역공능
Colorectal neoplasms%Elderly%Fast track surgery%Inflammatory reaction%Influence

目的：比较快速康复外科（FTS）与常规围手术期处理方法对老年结直肠癌患者术后免疫功能恢复和炎性应激反应及临床疗效的影响。方法前瞻性纳入2010年2月至2013年8月入住山东省枣庄市立第四医院外科的诊断明确的65岁以上老年结直肠癌患者，按随机数字表法分为快速康复外科组（快速康复组）与常规处理组（常规组）。比较手术前后两组患者T细胞亚群、炎性反应指标和脏器功能指标的变化及两组的差异及临床疗效。结果入组患者144例，年龄（76．5±4．8）岁。快速康复组和常规组各72例，两组患者临床基线资料差异无统计学意义（P＞0．05）。术后第3天，两组患者CD4＋和CD8＋均较术前上升（P＜0．05），但快速康复组术后CD4＋较常规组上升幅度明显（P＝0．003），CD8＋较常规组明显降低（P＝0．005）；快速康复组CD4＋／CD8＋比值较术前增加，并明显高于常规组（P＝0．001）；两组患者炎性反应指标水平均较术前明显上升（P＜0．05），但快速康复组变化幅度小于常规组（P＜0．05）；两组患者肌酐、钠尿肽和肌钙蛋白与术前比较，均明显升高（P＜0．05），但快速康复组升高幅度较常规组小（P＜0．05）。快速康复组患者术后开始进食时间、肛门排气时间、首次排粪时间均较常规组提前，围手术期恶心呕吐发生率和切口感染率明显降低，术后住院时间以及住院费用减少，差异均有统计学意义（P＜0．05）。结论快速康复外科能减轻老年结直肠癌患者围手术期脏器功能损伤，提高术后细胞免疫功能，降低患者手术应激反应，减少围手术期并发症发生率，提高临床疗效。
목적：비교쾌속강복외과（FTS）여상규위수술기처리방법대노년결직장암환자술후면역공능회복화염성응격반응급림상료효적영향。방법전첨성납입2010년2월지2013년8월입주산동성조장시립제사의원외과적진단명학적65세이상노년결직장암환자，안수궤수자표법분위쾌속강복외과조（쾌속강복조）여상규처리조（상규조）。비교수술전후량조환자T세포아군、염성반응지표화장기공능지표적변화급량조적차이급림상료효。결과입조환자144례，년령（76．5±4．8）세。쾌속강복조화상규조각72례，량조환자림상기선자료차이무통계학의의（P＞0．05）。술후제3천，량조환자CD4＋화CD8＋균교술전상승（P＜0．05），단쾌속강복조술후CD4＋교상규조상승폭도명현（P＝0．003），CD8＋교상규조명현강저（P＝0．005）；쾌속강복조CD4＋／CD8＋비치교술전증가，병명현고우상규조（P＝0．001）；량조환자염성반응지표수평균교술전명현상승（P＜0．05），단쾌속강복조변화폭도소우상규조（P＜0．05）；량조환자기항、납뇨태화기개단백여술전비교，균명현승고（P＜0．05），단쾌속강복조승고폭도교상규조소（P＜0．05）。쾌속강복조환자술후개시진식시간、항문배기시간、수차배분시간균교상규조제전，위수술기악심구토발생솔화절구감염솔명현강저，술후주원시간이급주원비용감소，차이균유통계학의의（P＜0．05）。결론쾌속강복외과능감경노년결직장암환자위수술기장기공능손상，제고술후세포면역공능，강저환자수술응격반응，감소위수술기병발증발생솔，제고림상료효。
Objective To compare the effect of rapid rehabilitation surgery (FTS) with the traditional operation method on postoperative immune function recovery , inflammatory reaction and the clinical efficacy in elderly patients with colorectal cancer. Methods A total of 144 elderly patients (older than 65 years) diagnosed as colorectal cancer in our department from February 2010 to August 2013 were prospectively enrolled in the study. According to the order of admission , patients were randomly divided into the fast track surgery group (72 cases, study group), and the traditional operation group (72 cases, control group). Preoperative and postoperative T cell subsets, inflammatory index and organ functional parameters were detected and compared. Result Basal clinical data of the two groups had no significant differences (all P>0.05). Three days after operation, CD4+ and CD8+ in both groups increased compared to preoperative levels (P<0.05), while the study group had greater increasing amplitude of CD4+(t=1.685, P=0.003), and lower CD8+(t=1.145, P=0.005) than the control group. CD4+/CD8+ increased in the study group compared to preoperation and significantly higher than that in the control group (P=0.001). Inflammatory stress indexes were significantly increased, while study group had smaller amplitude than the control group. Serum creatinine , B-natriuretic peptide and Troponin-T increased after operation , while the study group had smaller amplitude than the control group (P<0.05). The study group showed faster resumption of oral intake, quicker bowel function return, time to first defecation, hospital stay, lower incidences of nausea, vomiting, incision infection, and less cost of hospitalization. All the differences were significant (all P<0.05). Conclusion Fast track surgery can effectively protect the perioperative organ function, increase postoperative immune function, decrease inflammation stress reaction, reduce perioperative morbidity of complication, improve efficacy for elderly colorectal cancer patients.