腹腔镜辅助下全胃切除术对胃癌患者术后肠道功能及血清T细胞亚群、癌胚抗原水平的影响

摘要

目的 探讨腹腔镜辅助下全胃切除术对胃癌患者术后肠道功能及血清T细胞亚群、癌胚抗原(CEA)水平的影响.方法 选取本院2016年1月至2017年10月胃癌患者78例,随机数字表法分为对照组(n=39)与研究组(n=39).对照组采取开腹全胃切除术,研究组采取腹腔镜辅助下全胃切除术.统计两组手术情况及肠道功能恢复时间,术前及术后第1天血清CEA水平,术前及术后第1天、第3天血清T细胞亚群指标(CD3+、CD4+、CD8+、CD4+/CD8+)水平、并发症发生率.结果 两组淋巴结清扫数目比较,差异无统计学意义(P＞0.05);研究组术中失血量少于对照组,手术时长长于对照组,肠道功能恢复时间短于对照组(均P＜ 0.05);术后第1天,两组血清CEA水平较术前降低,且研究组低于对照组(均P＜ 0.05);术后第1天,两组血清CD3+、CD4+、CD4+/CD8+水平较术前降低,CD8+水平较术前增高(均P＜ 0.05);术后第3天两组血清CD3+、CD4+、CD4+/CD8+水平较术后第1天增高,CD8+水平较术后第1天降低(均P＜ 0.05),且术后各时间段研究组血清CD3+、CD4+、CD8+、CD4+/CD8+水平优于对照组(P＜0.05);研究组并发症发生率低于对照组(10.26％比28.21％,P＜0.05).结论 采取腹腔镜辅助下全胃切除术治疗胃癌,淋巴结清扫效果较好,可减少手术创伤,缩短术后肠道功能恢复用时,降低血清癌胚抗原水平,对机体免疫功能影响较小,且术后并发症发生率较低,具有安全性.%Objective To investigate the effect of laparoscopic assisted total gastrectomy on the intestinal function and serum levels ofT cell subsets and carcinoembryonic antigen (CEA) in patients with gastric cancer.Methods A total of 78 patients with gastric cancer treated at our hospital from January,2016 to October,2017 were selected and divided into a control group (n=39) and a study group (n=39).The control group were treated with open total gastrectomy,and the study group with laparoscopic assisted total gastrectomy.The operation and intestinal function recovery times,the serum level of CEA before and 1 d after operation,the serum levels of T cell subsets (CD3+,CD4+,CD8+,CD4+/CD8+) before and 1 and 3 d after operation,and the incidence of complications of the two groups were statistically analyzed.Results There was no statistical difference in the number of lymph node dissection between the two groups (P ＞ 0.05).The bleeding volume was lower,the operation time was longer,and the recovery time of the intestinal function was shorter in the study group than in the control group (all P ＜ 0.05).The serum level of CEA was lower 1 day after than before operation in both groups,and was lower in the the study group than in the control group 1 day after operation (P ＜ 0.05).The serum levels of CD3+and CD4+ and CD4+/CD8+ were lower and the level of CD8+ was higher 1 day after than before operation,in both groups (all P ＜ 0.05),were 1 than 3 days after operation in both groups (all P ＜ 0.05),and were in the study group than in the control group 1 and 3 days after the operations (all P ＜ 0.05).The incidence of complications was lower in the study group than in the control group (10.26％ vs.28.21％,P ＜ 0.05).Conclusion Laparoscopic assisted total gastrectomy for gastric carcinoma is excellently effective in lymph node dissection and safe,can reduce surgical trauma,the serum level of carcinoembryonic antigen,and postoperative complications,and shorten postoperative intestinal function recovery time.