摘要
目的观察术前免疫增强型肠内营养对结肠癌患者免疫及营养指标、癌细胞脱落、肿瘤增殖活性及预后的影响。方法纳入本院2012年1月至2014年10月收治的110例结肠癌患者为研究对象,随机分为观察组与对照组,每组均55例且术前均存在营养风险(NRS 2002≥3分),分别采取术前免疫增强型肠内营养及标准肠内营养干预。比较干预前后两组免疫、营养指标水平,观察腹腔和肠腔癌细胞脱落情况,通过增殖细胞核抗原(PCNA)观察细胞增殖指数(PI),记录复发、远处转移及生存情况。结果干预前,两组CD4^+/CD8^+、白蛋白及总蛋白水平差异无统计学意义(P>0.05);干预后,观察组术前1 d、术后7 d的CD4^+/CD8^+显著高于对照组(P<0.05),观察组术前1 d白蛋白显著高于对照组(P<0.05)。观察组腹腔、肠腔癌细胞脱落阳性率显著低于对照组(P<0.05),两组PI指数均无显著改变(P>0.05)。两组术后2年复发、远处转移率、生存率比较差异无统计学意义(P>0.05)。结论术前免疫肠内营养支持可改善术前免疫、营养状况,且未见促进癌细胞增殖,可降低腹腔、肠腔癌细胞脱落阳性率,但对预后并无显著改善。
Objective To investigate the effect of preoperative enhanced enteral nutrition（EN）on immune and nutritional parameters,tumor cell loss,tumor proliferation and prognosis in patients with colon cancer. Method 110 patients with colon cancer radical operation were randomly assigned to treatment group and control group,with 55 cases in each group. All patients had preoperative nutritional risk（NRS 2002 ≥ 3）. The treatment group preoperative immune-enhanced enteral nutrition and thecontrol group standard enteral nutrition intervention. Changes on immunization,nutritional indicators were compared between the two groups. Conditions of cells fallen off abdominal cavity and intestinal cancer were recorded. The cell proliferation index（PI）was measured by proliferating cell nuclear antigen（PCNA）. The recurrence,distant metastasis and survival rate were recorded. Result CD4~＋/CD8~＋ in the treatment group were significantly higher than those in the control group 1 day before and 7 days after operation（P〈 0.05）. Albumin in the treatment group was significantly higher than that in the control group 1 day before operation（P〈 0.05）. In the treatment group,the positive rate of exfoliative cells in the peritoneal cavity and intestinal cavity was significantly lower than those in the control group（P〈 0.05）. The PI index in both groups did not change significantly（P〉 0.05）. There was no significant difference in recurrence,distant metastasis rate and survival rate between the two groups（P〉 0.05）at 2-year follow-up. Conclusion Preoperative enteral nutrition support can improve preoperative immune and nutritional status. It does not promote the proliferation of cancer cells,but it can reduce the positive rate of the cancer cells in the peritoneal cavity and intestinal cavity. It has no significant effect on long-term prognosis.
出处
《结直肠肛门外科》
2017年第1期39-42,共4页
Journal of Colorectal & Anal Surgery
关键词
结直肠癌
营养支持
细胞脱落
增殖活性
colorectal cancer
cell shedding
nutritional support
proliferative activity
