Enhanced recovery after surgery can reduce immunosuppression and inflammation in patients with laparoscopic distal gastrectomy The aim of this study was to investigate the effect of fast-track surgery on inflammatory response and immune function in patients with laparoscopic radical gastrectomy. A total of 244 patients undergoing laparoscopic radical gastrectomy for gastric cancer from January 2014 to December 2017 were collected. The patients were divided into fast-track surgery (FTS) and traditional groups. The inflammatory index, immune index, and postoperative complications were measured before and after the operation. There was no significant difference in immune index between the two groups on the day before operation and one day after operation, all P > 0.05. On POD3 and POD6, the expression of CD3+, CD4+, CD4+/CD8+, IgG, IgM, and IgA in the FTS group was higher than that in the traditional group and the difference was statistically significant (P < 0.05).There was no significant difference in inflammation index between the two groups on the day before operation; on POD1, POD3, and POD6, the expression of IL-6, TNF-α, and CRP in the FTS group was lower than in the traditional group and the difference was statistically significant (P < 0.05). The total postoperative complications in the FTS group were significantly lower than those in the traditional group and the difference was statistically significant (P < 0.05). Fast-track surgery can effectively reduce the degree of postoperative inflammatory reaction and the incidence of postoperative complications compared with the traditional group and has a smaller impact on the body’s immune function, which is worthy of promotion in clinical practice.

目的 探讨腹腔镜间质瘤切除术与开腹胃间质瘤切除术对机体炎症反应和免疫功能的影响.方法 收集行胃间质瘤根治术且具有完整病例资料的患者140例,根据手术方式分为腹腔镜组(78例)和开腹组(62例),比较两组患者术前和术后的炎症指标和免疫指标.结果 术前第1天,两组患者炎症指标和免疫指标之间的差异无统计学意义(P>0.05).术后第1天和第7天,腹腔镜组中CD3+、CD4+、CD4+/CD8+及IgG、IgM、IgA的表达较开腹组高,IL-6、TNF-α和CRP的表达较开腹组低;差异均有统计学意义(均P<0.05).结论 与开腹胃间质瘤切除术相比较,腹腔镜胃间质瘤切除术能够有效降低术后炎症反应的程度,且对机体的免疫功能影响更小.

Multiple primary cancer (MPC), also known as repeated and multiple cancer, is a rare pathological phenomenon. It can be divided into two types. Patients with tumor interval within 6 months are called Synchronous Carcinoma (SC), and more than 6 months are called Metachronous Carcinoma (MC). Here, we report a case of MPC. The abdominal CT showed: a 30 mm * 34 mm round slightly low density shadow on the right kidney and the right wall of the rectum was unevenly thickened. The patient was diagnosed as MPC and treated with radical surgery. This unique case highlights that MPC should be considered if a patient is suspected of having metastatic tumor.

目的 探究胃癌部分切除术后补充双歧杆菌三联活菌对患者营养状态、炎症和免疫因子的影响,为肿瘤术后患者营养治疗支持提供建议.方法 选取2017年1月至2018年12月在我院行部分胃癌切除术的早期胃癌患者114例,采用随机数表法分为对照组(57例)与观察组(57例),两组患者于术后3～5 d开始进食,观察组在此基础上使用双歧杆菌三联活菌片,3粒/次,3次/日,口服,疗程14 d.对比两组治疗前后炎症因子水平(ELISA法测定外周血IL-2、IL-6及TNF-α水平)、免疫细胞水平(流式细胞仪测定外周血CD4+、CD8+、CD4YCD8+水平)、营养状态(蛋白质测定仪测定外周血白蛋白和总蛋白水平)及治疗不良反应.结果 治疗前两组IL-2、IL-6及TNF-α水平无明显差异(t=1.861,0.744,1.489;P=0.064,0.457,0.138),治疗后两组上述指标均较治疗前显著下降,其中观察组治疗后上述指标水平显著低于对照组(t=5.784,6.153,8.457;均P＜0.05);治疗前两组CD4+、CD8+、CD47 CD8+水平无明显差异(t=1.301,1.084,0.542;P=0.198,0.283,0.590),治疗后两组CD4+、CD4-/CD8+均较治疗前显著提高,CD8+显著下降,其中观察组治疗后CD4+、CD4+/CD8+水平显著高于对照组(t=5.205,3.904;均P＜0.05),CD8+显著低于对照组(t=6.507;P＜0.05);治疗前两组白蛋白及总蛋白水平无明显差异(t=1.301,0.651;P=0.198,0.518),治疗后两组上述水平均较治疗前显著提高,其中观察组治疗后白蛋白及总蛋白水平显著高于对照组(t=13.664,8.590;均P＜0.05);两组不良反应发生率无明显差异(5.26％vs 10.53％;x2=1.086,P=0.297).结论 胃癌部分切除术后补充益生菌可有效调节患者的炎症和免疫状态,显著改善营养状况.

Objective To compare the quality of life,nutritional status and immune function of gastric cancer patients with digestive tract reconstruction using Roux-en-Y anastomosis and uncut Roux-en-Y anastomosis after radical gastrectomy.Methods 86 patients with gastric cancer were selected from May 2015 to June 2017 with radical total gastrectomy.According to the different ways of the reconstruction of the digestive tract,the patients were divided into URY group (non-severed group,41 patients) and RY group (traditional group,45 patients).The quality of life of the two groups was compared at 1 month,3 months and 6 months after operation.The nutritional status of albumin,prealbumin,transferrin,hemoglobin,retinol binding protein and weight,as well as CD4+ lymphocyte,CD8+ lymphocyte,CD4+/CD8+ ratio,IgG,IgM,IgA and other immune related indexes were observed at pre-operation and 1 month,3 months and 6 months after operation.Results As for quality of life,the score of diet limitation in group URY was significantly lower than that in group RY at 1 month after operation (P＜0.05),and no significant difference at 3 months and 6 months after operation (P＞0.05);As for anxiety,the score of group URY was higher than that in group RY (P＜ 0.05) at 1 month after operation (P＜0.05),and was lower than that in group RY at 3 months and 6 months after operation (P＜0.05).As for dry mouth,group URY was higher than that in group RY (P＜0.05) at 3 months and 6 months after operation (P＜0.05),and the other indexes were not statistically significant (P＞ 0.05).As for the nutritional indexes,prealbumin in the URY group was higher than that in the RY group at 6 months after operation (P＜0.05),and the rest were not statistically significant (P＞0.05).There was no statistical significance in immune indexes between the two groups (P ＞ 0.05).The postoperative hospitalization time of URY group was less than that of RY group (P＜0.05),and the incidence of mild reflux symptoms was lower than that of RY group (P＜0.05).There was no significant difference in the incidence of other complications between the two groups (P＞0.05).Conclusion Except for the length of hospitalization and postoperative complications in which uncut Roux-en-Y anastomosis was superior to Roux-en-Y anastomosis,there is no significant difference in quality of life and nutritional and immune indicators between the two alimentary tract reconstruction methods.

根治性手术是目前公认的治疗胃癌患者的最有效途径,而全胃切除术后如何重建消化道的连续性则是更为重要的问题[1].尽管Roux-en-Y食管空肠吻合术是最常用的消化道重建术式[2],但是有些患者在采用Roux-en-Y吻合术后会发生Roux潴留综合征(RSS)[3],这症状包括慢性腹痛,反复的恶心呕吐以及体质量减轻,发生比例大约在30％左右[4].1988年,Stiegman和Goff报道了一种新的手术方式,即在BillrothⅡ式的基础上,闭合输入袢空肠,加用空肠-空肠吻合术来引流十二指肠液[5],这种新的消化道重建术式就是非离断式Roux-en-Y吻合术.

目的 探讨加速康复外科(ERAS)理念在胃癌根治术中的临床应用效果.方法 回顾性选取我院普外科2014年3月～2017年6月收治的采取根治性全胃切除的胃癌患者84例,根据围术期处理方式的不同分为ERAS组(n=41)和传统组(n=43),记录并比较两组患者围术期情况和并发症发生率.结果 ERAS组和传统组相比,肛门排气时间缩短,术后下床活动时间和术后首次进食流质时间显著提前,术后住院时间缩短(均P＜0.05);术后总的并发症发生率,ERAS组显著低于传统组(9.8％比34.9％,P＜0.05);两组患者均无肿瘤复发及死亡,吻合口狭窄和十二指肠残端瘘两组均未发生.结论 胃癌根治术围手术期采用加速康复外科(ERAS)理念,安全有效,可以使患者更快的康复,并减少术后并发症的发生.

术后胃瘫综合征(postoperative gastroparesis syn-drome,PGS)是腹部手术后早期常见的并发症.它主要发生在胃十二指肠手术后,也发生在非胃十二指肠手术中,是一种具有胃动力障碍和胃肠道非机械性阻塞特征的功能性疾病[1].PGS 的发病率随着手术的展开和手术时间的延长而增加[2].据报道,胰十二指肠切除术后 PGS 发生率达到 20％～50％,远端胃癌切除术后其发病率约为 4％～5％[3].大多数胃瘫患者单纯使用药物难以治愈,目前胃瘫的治疗都是综合治疗,包括饮食调整,血糖控制,止吐药物,促动力药物和手术干预,如胃电刺激(gastric electrical stimu-lation,GES),肉毒杆菌注射,幽门成形术等[4],但临床疗效不理想.本文对可能引起胃瘫的因素进行非条件 Logistic 回归分析,探讨引起胃瘫的危险因素,为临床诊治提供参考.