【摘要】 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)hvs(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%,χ~2=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。更多还原

【Abstract】 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%, χ~2=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.更多还原