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快速康复流程对老年直肠癌患者免疫功能的影响

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 IgA 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 IgG 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。

Comparative Study Between Automatic Ligation of Hemorrhoids and Procedure for Prolapsed Hemorrhoids on Elderly Patients with Hemorrhoids

ObjectiveTo compare the efficacy and safety of automatic ligation of hemorrhoids (ALH) and procedure for prolapsed hemorrhoids (PPH) in the treatment of elderly patients with hemorrhoids. MethodsOne hundred and eighty elderly patients with hemorrhoids who were admitted into the First People's Hospital of Jining City from January 2012 to December 2014 were enrolled. According to the operative mode, the patients were divided into ALH group and PPH group, with 90 cases in each group, received ALH and PPH treatment respectively. The postoperative pain, urinary retention, edema, bleeding, infection, anal swelling and anal stenosis were observed in the two groups, and two methods of operation were evaluated in terms of operation time, intraoperative bleeding, postoperative bleeding, postoperative pain, healing time, hospitalization expenses and postoperative complications. ResultsThe VAS scores of the ALH group in the day 1-3 after operation were lower than that of the PPH group, the difference was statistically significant (P < 0.05); the frequency of the use of analgesics in ALH group was less than that in PPH group (P < 0.01); the amount of blood loss and the healing time of the ALH group were significantly less or shoter than those of the PPH group (P < 0.01); the incidence of postoperative urinary retention in the ALH group was 2.22% (2/90), which was significantly lower than that of the PPH group, 27.78% (25/90), the difference was statistically significant (χ2=23.050, P=0.000); the incidence of perianal edema after operation in the ALH group was 5.56% (5/90), which was significantly lower than that of PPH group of 15.56% (14/90), the difference was statistically significant (χ2=4.766, P=0.029). There was no obvious postoperative bleeding in the ALH group(0/90), while the incidence of postoperative bleeding in the PPH group was 7.78% (7/90), and the difference between the two groups was statistically significant (Fisher's exact test, P=0.007). The efficiency of ALH group was 98.89% (89/90) and the PPH group was 97.78% (88/90), the difference between the two groups was not statistically significant (χ2=0.339, P=0.560). Conciusions There is no significant difference between ALH and PPH in the treatment of elderly patients with hemorrhoids, but ALH has the advantages of less pain, quicker recovery and fewer complications, it is worthy of popularization and application.

直肠黏膜下纤维脂肪瘤 1 例报道