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快速康復流程對老年直腸癌患者免疫功能的影響

目的 比較快速康復流程（ERAS）與常規處理方法對老年直腸癌患者行經腹會陰聯合切除術（abdominoperineal resection，APR）后免疫功能和炎癥反應的影響。 方法 前瞻性收集 2014 年 1 月至 2015 年 12 月期間山東省濟寧市第一人民醫院肛腸外科收治的老年直腸癌患者 116 例，隨機分為 ERAS 組與傳統治療組，各 58 例，比較 2 組患者的臨床效果，并比較 2 組患者手術前后炎癥反應指標、T 細胞亞群及體液免疫指標的差異。 結果 ① 與傳統治療組比較：ERAS 組患者的術后開始進食時間、首次排氣時間、首次排便時間及術后住院時間短，術后住院費用少，圍手術期惡心嘔吐發生率和切口感染率均較低（P<0.05）。② 炎癥反應指標：術后 3 d 和 6 d 時，同時點 ERAS 組患者的 C 反應蛋白（CRP）水平均較傳統治療組低（P<0.001）；術后 1、3 和 6 d 時，同時點 ERAS 組患者的血清淀粉樣蛋白 A（serum amyloid A protein，SAA）和白細胞介素-6（IL-6）水平均較傳統治療組低（P<0.001）。③ T 細胞亞群：術后 1、3 和 6 d 時，同時點 ERAS 組患者的 CD3+ 細胞比例、CD4+ 細胞比例及 CD4+/CD8+ 細胞比值均較傳統治療組高（P<0.05）。④ 體液免疫指標：術后 3 d 時，ERAS 組患者的 IgA 水平較傳統治療組高（P<0.001）；術后 1、3 及 6 d 時，ERAS 組患者的 IgG 和 C3 水平均較傳統治療組高（P<0.05）。 結論 ERAS 對老年直腸癌 APR 后免疫功能的影響較傳統治療小，能夠降低手術后的應激反應，促進術后細胞免疫功能和體液免疫功能的恢復，減少術后并發癥的發生，值得臨床推廣應用。

直腸黏膜下纖維脂肪瘤 1 例報道

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.