Okamoto Yoshiki, Okano Keiichi, Izuishi Kunihiko, Usuki Hisashi, Wakabayashi Hisao, Suzuki Yasuyuki
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
World J Surg. 2009 Sep;33(9):1815-21. doi: 10.1007/s00268-009-0140-1.
Past trials have shown perioperative immunonutrition to improve the outcome for patients with gastric cancer. The present study was designed to evaluate the effect of preoperative oral immunonutrition on cellular immunity, the duration of the systemic inflammatory response syndrome (SIRS), and detailed postoperative complications in patients with gastric cancer.
Sixty patients with gastric cancer were randomly assigned to two groups: one group received immune-enhanced formulas supplemented with arginine and omega-3 fatty acids (immune-enhancing diet (ID) group, n = 30); the other received standard formulas (conventional diet (CD) group, n = 30) for 7 days before the operation. These groups were well matched in terms of age, sex, operations, cancer stages, and intraoperative variables. The postoperative outcome was evaluated based on clinical variables, including postoperative infectious complications, noninfectious complications, and SIRS duration. In addition, the perioperative state of cellular immunity was evaluated and compared between the two groups.
The incidence of postoperative infectious complications in the ID group (6%) was significantly (p < 0.05) lower than that of the CD group (28%). The duration of SIRS in the ID group (0.77 +/- 0.9 days) was significantly (p < 0.05) shorter than that in the CD group (1.34 +/- 1.45 days). The postoperative lymphocyte and CD4(+)T-cell counts significantly decreased (p < 0.05) in both groups. However, the number of CD4(+)T-cells on preoperative day 1 and postoperative day 7 was significantly (p < 0.05) higher in the ID group than in the CD group.
Preoperative oral immune-enhanced formulas supplemented with arginine and omega-3 fatty acids enhanced the immune status of the patients, reduced the duration of SIRS, and decreased the incidence of postoperative infectious complications. CD4(+)T-cell immunity likely played an important role in the modulation of the postoperative immune and inflammatory response after gastrectomy.
既往试验表明围手术期免疫营养可改善胃癌患者的预后。本研究旨在评估术前口服免疫营养对胃癌患者细胞免疫、全身炎症反应综合征（SIRS）持续时间及详细术后并发症的影响。
60例胃癌患者随机分为两组：一组在术前7天接受补充精氨酸和ω-3脂肪酸的免疫增强型配方（免疫增强饮食（ID）组，n = 30）；另一组接受标准配方（传统饮食（CD）组，n = 30）。两组在年龄、性别、手术方式、癌症分期及术中变量方面匹配良好。根据临床变量评估术后结局，包括术后感染性并发症、非感染性并发症及SIRS持续时间。此外，评估并比较两组围手术期细胞免疫状态。
ID组术后感染性并发症发生率（6%）显著低于CD组（28%）（p < 0.05）。ID组SIRS持续时间（0.77 ± 0.9天）显著短于CD组（1.34 ± 1.45天）（p < 0.05）。两组术后淋巴细胞及CD4(+)T细胞计数均显著降低（p < 0.05）。然而，ID组术前第1天和术后第7天的CD4(+)T细胞数量显著高于CD组（p < 0.05）。
术前口服补充精氨酸和ω-3脂肪酸的免疫增强型配方可增强患者免疫状态，缩短SIRS持续时间，降低术后感染性并发症发生率。CD4(+)T细胞免疫可能在胃切除术后的免疫和炎症反应调节中起重要作用。
