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目的比较快速康复流程(ERAS)与常规处理方法对老年直肠癌患者行经腹会阴联合切除术(abdominoperineal resection,APR)后免疫功能和炎症反应的影响。方法前瞻性收集2014年1月至2015年12月期间山东省济宁市第一人民医院肛肠外科收治的老年直肠癌患者116例,随机分为ERAS组与传统治疗组,各58例,比较2组患者的临床效果,并比较2组患者手术前后炎症反应指标、T细胞亚群及体液免疫指标的差异。结果 (1)与传统治疗组比较:ERAS组患者的术后开始进食时间、首次排气时间、首次排便时间及术后住院时间短,术后住院费用少,围手术期恶心呕吐发生率和切口感染率均较低(P<0.05)。(2)炎症反应指标:术后3 d和6 d时,同时点ERAS组患者的C反应蛋白(CRP)水平均较传统治疗组低(P<0.001);术后1、3和6 d时,同时点ERAS组患者的血清淀粉样蛋白A(serum amyloid A protein,SAA)和白细胞介素-6(IL-6)水平均较传统治疗组低(P<0.001)。(3)T细胞亚群:术后1、3和6 d时,同时点ERAS组患者的CD3+细胞比例、CD4+细胞比例及CD4+/CD8+细胞比值均较传统治疗组高(P<0.05)。(4)体液免疫指标:术后3 d时,ERAS组患者的Ig A水平较传统治疗组高(P<0.001);术后1、3及6 d时,ERAS组患者的Ig G和C3水平均较传统治疗组高(P<0.05)。结论 ERAS对老年直肠癌APR后免疫功能的影响较传统治疗小,能够降低手术后的应激反应,促进术后细胞免疫功能和体液免疫功能的恢复,减少术后并发症的发生,值得临床推广应用。
Objective To compare the effects of rapid rehabilitation procedure (ERAS) and conventional treatment on immune function and inflammatory response in elderly patients with rectal cancer after perineal abdominoperineal resection (APR). Methods One hundred and sixty-six patients with senile rectal cancer who were admitted to Department of Anorectal Surgery, First People’s Hospital of Jining City, Shandong Province from January 2014 to December 2015 were prospectively collected. They were randomly divided into ERAS group and traditional treatment group, 58 cases each. The clinical effects of the patients were compared, and the differences of inflammatory response indexes, T cell subsets and humoral immunity before and after surgery were compared between the two groups. Results (1) Compared with the traditional treatment group, the time of postprandial feeding, the time of the first discharge, the time of the first defecation, the length of postoperative hospital stay, the postoperative hospitalization cost, the incidence of perioperative nausea and vomiting, The infection rate was lower (P <0.05). (2) Inflammatory reaction index: The levels of C-reactive protein (CRP) in ERAS group were lower than those in the traditional treatment group at 3 d and 6 d after operation (P <0.001); at 1, 3 and 6 d after operation Serum amyloid A protein (SAA) and interleukin-6 (IL-6) levels in patients with ERAS were lower than those in the traditional treatment group (P <0.001). (3) T cell subsets: The proportion of CD3 + cells, the ratio of CD4 + cells and the ratio of CD4 + / CD8 + cells in ERAS group were significantly higher than those in the traditional treatment group at 1, 3 and 6 days after operation (P <0.05). (4) The indexes of humoral immunity: The level of Ig A in ERAS group was higher than that in the traditional treatment group at 3 days after operation (P <0.001). At 1, 3 and 6 days after operation, the levels of Ig G and C3 Were higher than the traditional treatment group (P <0.05). CONCLUSIONS: The effect of ERAS on the immune function of elderly patients with rectal cancer after APR is less than that of conventional therapy. It can reduce the postoperative stress response, promote the recovery of postoperative cellular immunity and humoral immunity, and reduce the incidence of postoperative complications. It is worthy of clinical promotion application.