食管胃结合部癌患者姑息性全胃切除术中行脾脏保留对免疫功能的影响

摘要

目的 探讨食管胃结合部癌患者姑息性全胃切除术中行脾脏保留对免疫功能的影响.方法 2012年10月-2014年10月海南省儋州市人民医院收治的98例食管胃结合部癌患者作为研究对象,根据手术中脾脏是否保留分为保脾组52例和切脾组46例.保脾组给予姑息性全胃切除术,切脾组给予姑息性全胃切除术+脾脏切除术.比较2组患者手术情况,免疫球蛋白(IgA、IgG、IgM)水平及T淋巴细胞亚群(CD3+、CD4+、CD8+)水平变化情况;术后随访并记录2组患者生存情况.结果 保脾组在手术时间、术中出血量、胃肠功能恢复时间及流质饮食时间明显短于/少于切脾组(P<0.05);术后10 d,2组患者IgA、IgG、IgM、CD3+、CD4+、CD4+/CD8+水平较术前明显升高(P＜0.05);术后1个月,保脾组较术后10 d IgA、IgG、IgM、CD3+、CD4+、CD4+/CD8+水平无明显变化(P＞0.05),而切脾组IgA、IgG、IgM、CD3+、CD4+、CD4+/CD8+水平恢复至术前水平,差异具有统计学意义(P＜0.05).保脾组术后1个月IgA、IgG、IgM和CD3+、CD4+、CD4+/CD8+水平高于切脾组(t=3.206,6.243,3.809,3.705,2.707,2.342,P＜0.05);2组患者随访12~24个月,中位随访时间16.3个月,保脾组1年生存率为42.1%,切脾组为39.3%,2组间比较差异无统计学意义(X2=0.084,P=0.773).结论 晚期食管胃结合部癌患者姑息性全胃切除术中应尽量保留脾脏,有利改善患者免疫功能,对于术后预后具有一定的临床意义.%Objective To investigate the effect of spleen preservation on immune function in patients with adenocarcinoma of gastroesophageal junction undergoing palliative total gastrectomy.Methods Ninety-eight cases of patients with adenocarcinoma of gastroesophageal junction were selected, who were treated in hospital from October 2012 to October 2014, and they were divided into the observation group (52 cases) and control group (46 cases) according to whether the spleen was retained or not.The patients of observation group were treated with palliative total gastrectomy and spleen retention, while the patients of control group were treated with palliative total gastrectomy and splenectomy.The operation and postoperative follow up of 1 to 24 months of survival and changes of the levels of immunoglobulin (IgA, IgG, IgM) and T lymphocyte subsets (CD3+,CD4+,CD8+) of two groups were compared.Results The operation time, intraoperative blood loss, gastrointestinal function recovery time and fluid diet time of the observation group were significantly lower than those of the control group (P<0.05);The levels of IgA, IgG, IgM, CD3+,CD4+ and CD4+/CD8+ in the two groups were significantly higher than before on the 10th postoperative day (P<0.05);There were no significant changes in IgA, IgG, IgM,CD3+,CD4+,CD+4/CD8+ levels in the observation group at 1 month after operation compared to the 10th postoperative day (P>0.05), while the levels of IgA, IgG, IgM, CD3+,CD4+,CD4+/CD8+ recovered to preoperative levels in the control group, the difference was statistically significant(t=3.206,t=6.243,t=3.809,t=3.705,t=2.707,t=2.342,P＜0.05);After follow up of 1 to 24 months (median follow up of 16.3months), the one year survival rate was 42.1% in the observation group and 39.3% in the control group, there was no significant difference between the two groups (X2=0.084,P=0.773).Conclusion The patients with adenocarcinoma of gastroesophageal junction undergoing palliative total gastrectomy should retain the spleen, which is beneficial to improve the immune function, and has a certain clinical significance for postoperative prognosis.