腹腔镜与开腹胃楔形切除术对GIST患者营养状况、T细胞亚群和预后的影响

摘要 目的：探讨腹腔镜与开腹胃楔形切除术对胃间质瘤（GIST）患者营养状况、T细胞亚群和预后的影响。方法：回顾性分析2013年1月~2014年2月期间我院收治的GIST患者97例的临床资料，根据手术方式的不同将患者分为对照组（n=47，开腹胃楔形切除术）和研究组（n=50，腹腔镜胃楔形切除术），对比两组患者手术相关指标、营养状况、T细胞亚群、预后情况。结果：研究组住院时间、肛门排气时间、切口长度、手术时间短于对照组，术中出血量少于对照组（P<0.05）。两组患者术后7 d前白蛋白、转铁蛋白、白蛋白均降低，但研究组高于对照组（P<0.05）。两组术后7 d的 CD4⁺/CD8⁺、CD3⁺、CD4⁺较术前下降，CD8+较术前升高（P<0.05）；研究组术后7 d 的CD4⁺/CD8⁺、CD3⁺、CD4⁺高于对照组，CD8⁺则低于对照组（P<0.05）。研究组并发症总发生率低于对照组（P<0.05）；两组术后复发率、5年生存率比较无统计学差异（P>0.05）。结论：与开腹胃楔形切除术相比，GIST患者采用腹腔镜胃楔形切除术治疗的远期预后效果相当，可有效改善围术期相关指标，对患者营养状况、T细胞亚群的影响较轻，且可减少术后并发症的发生率。

Effect of Laparoscopic and Open Stomach Wedge Resection on Nutritional Status, T Cell Subsets and Prognosis of Patients with GIST

ABSTRACT Objective: To investigate the effect of laparoscopic and open wedge resection on the nutritional status, T cell subsets and prognosis of patients with gastric stromal tumor (GIST). Methods: The clinical data of 97 patients with GIST in our hospital from January 2013 to February 2014 were retrospectively selected. According to the different operation methods, the patients were divided into the control group (n=47, open stomach wedge resection) and study group (n=50, laparoscopic stomach wedge resection). The operation related indexes, nutritional status, T cell subsets and prognosis of the two groups were compared. Results: The time of hospitalization, anal exhaust, incision length and operation in the study group were shorter than those in the control group, and the amount of bleeding in the operation was less than that in the control group (P<0.05). The prealbumin, transferrin and albumin in the two groups at 7 days after operation were lower than those before operation, but those in the study group were higher than those in the control group (P<0.05). The CD4⁺/CD8⁺, CD3⁺, CD4⁺ in the two groups at 7 days after operation were lower than those before operation, while CD8⁺ was higher than that before operation (P<0.05). The CD4⁺/CD8⁺, CD3⁺, CD4⁺ in the study group at 7 days after operation were higher than those in the control group, while CD8⁺ was lower than that in the control group (P<0.05). The total incidence rate of complications in the study group was lower than that in the control group (P<0.05). There were no differences in the postoperative recurrence rate and 5-year survival rate between the two groups (P>0.05). Conclusion: Compared with open stomach wedge resection, the long-term prognosis of GIST patients treated with laparoscopic gastric wedge resection is similar, it can effectively improve the perioperative related indicators, it has less impact on the nutritional status and T cell subsets of patients, and reduce the incidence of postoperative complications.