摘要
目的探讨应用快速康复外科(FTS)理念降低开腹和腹腔镜结直肠癌根治术患者应激反应和加速术后康复的效果。方法选择2012年5月至2016年12月在浦北县人民医院住院行结直肠癌根治手术的患者120例,随机分为单纯开腹结直肠癌根治术组(A组)、FTS理念开腹结直肠癌根治术组(B组)、FTS理念腹腔镜结直肠癌根治术组(C组),每组各40例。观察三组手术时间、术中出血量、淋巴结清扫数目、术后首次肛门排气时间、排便时间、术后住院天数、住院费用、术后并发症发生情况以及C-反应蛋白(CPR)、白介素-6(IL-6)、白细胞(WBC)等应激反应指标。结果三组手术时间、术中出血量、术后首次肛门排气时间、排便时间、术后住院天数、住院费用比较差异均有统计学意义(均P<0.05)。B组比A组术后首次肛门排气时间及排便时间提前、术后住院天数缩短、住院费用降低(P<0.05)。C组与B组比较,淋巴结清扫数目、术后首次肛门排气时间及排便时间、住院天数差异均无统计学意义(均P>0.05),手术时间C组比B组长(P<0.05),住院费用C组比B组高(P<0.05),C组比B组术中出血量少(P<0.05)。三组术后第1 d WBC、CPR、IL-6均较术前升高,第3 d、7 d逐渐下降,差异均有统计学意义(均P<0.05)。经比较,A组WBC、CPR、IL-6术后显著高于B组(P<0.05)。C组与B组比较,术后WBC、CPR、IL-6差异均无统计学意义(P>0.05)。术后并发症情况:A组腹胀3例、吻合口漏1例;B组恶心、腹胀、切口感染各2例,吻合口漏1例;C组腹胀2例、肺部感染1例;均无吻合口出血、肠梗阻、尿潴留等并发症。结论结直肠癌患者术后均产生不同程度的应激反应,FTS能显著降低开腹和腹腔镜结直肠癌根治术患者术后的应激反应,加快患者术后胃肠功能恢复,促进患者康复,缩短住院时间,且不增加患者术后并发症的发生率,值得推广应用。
Objective To investigate the role of fast track surgery （FI＇S） in reducing stress response and facilitate postoperative recovery in patients undergoing open and laparoscopic radical resection of colorectal cancer. Methods 120 patients undergoing colorectal cancer surgery were randomly divided into 3 groups： open surgery group （group A）, FTS concept of open surgery group （group B）, the Frs concept of laparoscopic surgery group （group C）, with 40 cases in each group. Patients in group A, group B and group C were treated with open radical resection of colorectal cancer, FTS concept of radical resection of colorectal cancer, FTS concept laparoscopic radical resection of colorectal cancer, respectively. Results There were significantly between-group differences in operation time, intraoperative blood loss, postoperative anal exhaust time, time to first defecate, postoperative hospitalization duration, and hospitalization cost （P 〈 0.05）. Compared with group A, group A had shorter time to first anal exhaust and time to first defecation, shorten hospitalization stay and lower hospitalization costs （P 〈 0.05）. Compared with Group B, the number of dissected lymph nodes, time to first anal exhaust, time to first defecation, and duration of hospitalization were similar in group C and operation duration was longer, hospitalization costs higher, intraoperative blood loss fewer in group C （P 〈 0.05）. The levels of WBC, CRP and IL-6 increased ld postoperatively in all groups and decreased gradually on 3d and 7d postoperatively （P 〈 0.05）. Such increases were more prominent in Group A than in group B （P 〈 0.05） and there was no significantly difference between group C and group B （P 〈 0.05）. In group A, postoperative complications included 2 cases of abdominal distension and 1 case of anastomotic fistula. In group B, they included 2 cases each for nausea, abdominal distension and infection of incision, respectively, and 1 case of leakage. In group C, they included 2 cases o
作者
张良清
黄安振
高海鸿
Zhang Liangqing Huang Anzhen Gao Haihong(The First Ward of General Surgery, People＇s Hospital of Pubei County, Qinzhou, Guangxi, 535300, China Department of General Surgery, Traditional Chinese Medicine Hospital of Pubei County, Qinzhou, Guangxi, 535300, China)
出处
《结直肠肛门外科》
2017年第2期165-169,共5页
Journal of Colorectal & Anal Surgery
关键词
快速康复外科
腹腔镜手术
结直肠癌
应激反应
fast track surgery, laparoscopic surgery, colorectal cancer, stress response
