摘要
目的 探讨局部进展期胃癌患者接受腹腔镜或开腹远端胃切除术对患者围手术期炎性指标影响的差异.方法 按照随机对照研究设计,将人组患者随机分为腹腔镜手术组和开腹手术组,分别于术前、术后第1天、术后第3天和术后第5天检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、CD4细胞、CD8细胞和NK细胞等指标,并分析两组患者间各项炎症指标差异、变化趋势以及对术后并发症的影响.两组间基线数据、炎症指标以及术后并发症差异比较采用t检验,Mann-Whitney U检验或卡方检验.结果 本研究纳入135例患者(腹腔镜组67例,开放组68例).两组患者的基线数据均衡.腹腔镜组对比开放组患者在术前、术后相应时间点[中位数(IQR)]的I L-6[6.09(2.52～10.60)、70.11(39.17～118.00)、34.00(19.59～65.16、20.52(11.76～43.10);5.84(2.45～16.10)、71.70(41.39～134.00)、45.30(16.96～76.30)、16.89(10.23～37.86),Z=-0.367、-0.350、-0.552、-0.771]、TNF-a[11.80(8.82～22.25)、12.70(9.30～25.23)、19.10(13.68～24.80)、13.70(10.97～20.65);11.15(8.34～18.02)、11.20(9.15～19.10)、15.25(13.10～23.73)、15.40(10.95～24.52),Z=-0.941、-0.827、-1.521、-0.717]、CD4 细胞[41.94(36.66～47.14)、34.99(27.35～38.77)、38.81(34.20～47.12)、43.83(38.48～49.89);42.25(38.41～45.08)、33.17(27.73～38.23)、40.54(35.74～44.13)、43.74(38.92～49.04),Z=-0.157、-0.998、-0.036、-0.561]、CD8 细胞[20.23(17.63～25.77)、21.11(17.94～25.48)、20.07(16.61～24.51)、19.64(16.94～25.28);24.39(20.24～27.67)、23.62(19.20～29.07)、23.09(18.32～25.31)、21.57(19.29～25.35),Z=-1.899、-1.345、-1.400、-1.095]、NK 细胞[14.91(10.45～19.50)、16.13(12.40～22.31)、13.22(9.02～17.63)、10.15(7.85～15.13);12.69(8.26～17.50)、16.81(12.30～23.93)、12.04(9.09～16.92)、10.22(7.27～15.10),Z=-1.314、-0.190、-0.765、-0.321]的差异均无统计学意义(P＞0.05),且动态变化趋势以及与术后并发症发生差异无统计学意义[13(19.4％)例;11(16.2％)例,x2=0.240,P＞0.05].结论 对于局部进展期胃癌,腹腔镜手术后围手术期炎性指标变化与开腹手术差异无统计学意义,提示腹腔镜手术除了微创优势外,手术应激相关优势需深入探讨.
Abstract
Objective To compare perioperative inflammatory states between laparoscopic gastrec-tomy and open gastrectomy in locally advanced gastric cancer.Methods Data of eligible patients were re-trieved from CLASS-01(NCT01609309)trial.Patients were divided into groups of laparoscopic gastrectomy and open gastrectomy.Serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),CD4 cells,CD8 cells,NK cells were tested before surgery,and on the postoperative day 1,postoperative day 3,postopera-tive day 5,respectively.The dynamic changes of inflammatory factors and postoperative infectious compli-cations were compared between the two groups.The t test,Mann-Whitney U test or chi-square test was used to compare the differences in baseline data,inflammatory indicators and postoperative complications between the two groups.Results A total of 135 patients were enrolled in this study,including 67 in the laparoscopic gastrectomy group and 68 in the open gastrectomy group.The basic population data of two groups were similar.There were no significant differences between the two groups patients in the levels of serum interleukin-6[6.09(2.52-10.60),70.11(39.17-118.00),34.00(19.59-65.16),20.52(11.76-43.10)vs.5.84(2.45-16.10),71.70(41.39-134.00),45.30(16.96-76.30),16.89(10.23-37.86),Z=-0.367,-0.350,-0.552,-0.771],tumor necrosis factor-α[11.80(8.82-22.25),12.70(9.30-25.23),19.10(13.68-24.80),13.70(10.97-20.65)vs.11.15(8.34-18.02),11.20(9.15-19.10),15.25(13.10-23.73),15.40(10.95-24.52),Z=-0.941,-0.827,-1.521,-0.717],CD4 cells[41.94(36.66-47.14),34.99(27.35-38.77),38.81(34.20-47.12),43.83(38.48-49.89)vs.42.25(38.41-45.08),33.17(27.73-38.23),40.54(35.74-44.13),43.74(38.92-49.04),Z=-0.157,-0.998,-0.036,-0.561],CD8 cells[20.23(17.63-25.77),21.11(17.94-25.48),20.07(16.61-24.51),19.64(16.94-25.28)vs.24.39(20.24-27.67),23.62(19.20-29.07),23.09(18.32-25.31),21.57(19.29-25.35),Z=-1.899,-1.345,-1.400,-1.095],NK cells[14.91(10.45-19.50),16.13(12.40-22.31),13.22(9.02-17.63),10.15(7.85-15.13)vs.12.69(8.26-17.50),16.81(12.30-23.93),12.04(9.09-16.92),10.22(7.27-15.10),Z=-1.314,-0.190,-0.765,-0.321]at corresponding time points before and after surgery(all P＞0.05).Additionally,there were no significant differences in the dynamic trends of these inflammatory factors and their association with postoperative complications[13(19.4％)vs.11(16.2％),x2=0.240,P＞0.05].Conclusion The perioperative inflammatory states between laparoscopic gastrectomy and open gastrectomy are close in locally advanced gastric cancer,further confirming the perspective that the opera-tion of laparoscopic gastrectomy and open gastrectomy is not the pivotal factors in determining the periopera-tive inflammatory state.
基金项目
广东省自然科学基金(2023A1515010785)
广东省重点领域研发计划(2021B0101420005)
广东省重大人才工程(2019JC05Y361)
NETL
NSTL
万方数据