摘要
目的探讨快速康复外科理念在结直肠癌患者中行腹腔镜经自然腔道标本取出手术(NOSES)的应用价值。方法选取2017年3月至2018年5月唐山市工人医院收治的结直肠癌患者86例,应用随机数字表法分为观察组和对照组,各43例。两组患者均严格依据操作规范行NOSES,对照组采用传统干预措施,观察组应用快速康复外科理念(ERAS),患者于手术前12 h口服电解质溶液进行肠道准备,无需常规留置胃肠减压管,术前禁食6 h,禁水2 h,术前3 h口服10%葡萄糖,术中保温,控制输液量,术后不放置引流管,采用多模式镇痛,术后第1天离床活动,给予流质饮食,并逐步过渡为正常饮食。比较观察组和对照组患者的术中出血量、淋巴结清扫枚数、手术时间、住院时间、住院费用以及术后首次饮水时间、饮食时间、排气时间、下床活动时间,比较两组患者手术前、后焦虑自评量表(SAS)和抑郁自评量表(SDS)评分、术后Barthel指数和并发症发生情况。结果观察组和对照组患者的术中出血量、淋巴结清扫枚数和手术时间比较,差异均无统计学意义(均P>0.05)。观察组患者的术后住院时间[(6.8±1.2)d]短于对照组[(8.5±1.5)d],住院费用[(5.8±1.0)万元]少于对照组[(6.9±1.2)万元],差异均有统计学意义(均P<0.05)。观察组患者的术后首次饮水时间、饮食时间、排气时间和下床活动时间分别为(1.31±0.35)d、(1.8±0.4)d、(2.4±0.5)h和(12.0±2.4)h,对照组分别为(2.28±0.24)d、(3.0±0.4)d、(2.9±0.6)h和(16.8±2.5)h,差异均有统计学意义(均P<0.05)。术前,观察组和对照组患者的SAS和SDS评分比较,差异均无统计学意义(均P>0.05);术后,观察组患者的SAS和SDS评分分别为(57±7)分和(57±4)分,对照组分别为(69±8)分和(62±9)分,差异均有统计学意义(均P<0.05)。观察组患者的并发症发生率为7.0%(3/43),低于对照组[27.9%(12/43)],差异有统计学意义(P=0.011)。结论NOSES与ERAS联合可
Objective To discuss the role of enhanced recovery after surgery (ERAS) in patients with colorectal carcinoma after natural orifce specimen extraction surgery (NOSES). Methods From March 2017 to May 2018, 86 patients diagnosed with colorectal carcinoma and received NOSES at Tangshan Gongren Hospital were randomized to the control group and the observation group. Doctors utilized traditional interventions in the control group. In the observation group were orally administered with electrolyte solution for 12 hours before surgery, without gastrointestinal decompression tube routinely. Patients were fasting for 6 hours before surgery, 2 hours of water inhalation, and oral administration of 10% glucose 3 hours before surgery. During surgery, patients received intraoperative warming and controlled infusion volume. After operation, no drainage tube was placed, and multi-mode analgesia was used. The patient was given a fluid diet on the first day after surgery, and gradually transitioned to a normal diet. The intraoperative blood loss, number of lymph node dissection, operation time, hospitalization time, hospitalization expenses, first drinking time after surgery, diet time, exhaust time, time to get out of bed, pre-and post-operative self-rating anxiety scale (SAS) and self-rating depression scale (SDS) score, postoperative Barthel index and complication were compared between the two groups. Results The intraoperative blood loss, number of lymph node dissection, and operation time were almost the same between the two groups (all P>0.05). The hospitalization time (6.8±1.2 d versus 8.5±1.5 d) and expenses (58±10 thousand Yuan versus 69±12 thousand Yuan) were significantly reduced in The first drinking time after surgery(1.31±0.35 d versus 2.28±0.24 d), diet time(1.8±0.4 d versus 3.0±0.4 d), exhaust time(2.4±0.5 d versus 2.9±0.6 d), and time to get out of bed (12.0±2.4 d versus 16.8±2.5 d) were all earlier in the observation group (all P<0.05). The SAS and SDS score before the operation were similar between t
作者
郝世柱
张晋冀
Hao Shizhu;Zhang Jinji(Department of the First Surgical Oncology,Tangshan Gongren Hospital,Tangshan 063000,China;Department of Surgical Oncology,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2019年第10期796-800,共5页
Chinese Journal of Oncology
