【摘要】 目的:评估结直肠手术应用加速康复外科(ERAS)的临床效果,分析影响ERAS实施效果的相关因素。方法:回顾性分析了张家港澳洋医院2015年1月到2017年2月收治的167例因结直肠癌行结直肠切除的病人的临床资料。其中,2015年1月到2016年3月,共89例病人采用传统的围手术期处理方案,设为传统方案组。从2016年4月到2017年2月,共78例病人采用ERAS围手术期处理方案,设为ERAS组。对两组病人基线资料,围手术期情况以及术后结局进行比较分析。结果:ERAS组和传统方案组相比,两组的基线数据如年龄、性别、BMI、肿瘤部位、肿瘤组织学分级及分期之间没有显著性差异(P>0.05)。术中情况比较,ERAS组更多的采用腹腔镜的手术方式,术中需要输血的病人比例低于传统方案组(P<0.05)。术后结局比较,ERAS组在术后排气时间、术后住院时间以及术后ICU住院时间均低于传统方案组,且术后I级并发症以及II级并发症的发生率降低,差异具有统计学意义。单因素及多因素分析的结果表明,腹腔镜的手术方式是保证ERAS实施效果的独立保护性因素(OR:0.33,95%CI=0.22~0.47,P=0.005),而术前CRP水平则是影响ERAS实施效果的独立危险因素(OR:3.97,95%CI=3.26~4.35,P=0.016)。结论:本研究再次证实在结直肠外科中,ERAS方案的实施可以缩短病人术后排气时间、术后住院时间以及术后ICU住院时间。同时,ERAS可以降低术后I-II级并发症的发生。并且对于结直肠手术病人,腹腔镜的应用以及术前病人CRP水平关系到ERAS的实施效果。更多还原

【Abstract】 Objective: TTo assess the implementation effects of ERAS for colorectal surgery patients, and to analyze the factors influencing the result of ERAS. Methods: A total of 167 patients with colorectal cancer receiving colorectal resection in Ao Yang hospital from January 2015 to February 2017 were analyzed retrospectively, including conventional group(n = 89) treated with traditional perioperative management from January 2015 to March 2016, and ERAS group treated with ERAS program from March 2016 to February 2017. The baseline data, perioperative and postoperative outcomes between the two groups were compared. Results: The base line data including age, gender, BMI, site of the tumor and the tumor stage and grade showed no significant difference between ERAS and conventional group(P > 0.05). During operation, laparoscopies were more often used in ERAS group, and the percentage of patients who needed intraoperative blood transfusion in ERAS group was significantly less than that in conventional group(P< 0.05). Regarding the post-operative outcomes, the time to first flatus, hospital and ICU stay after operation in ERAS group were all significantly shorter than conventional group. Moreover, the incidence of Grade I and II postoperative complications was statistically decreased in ERAS group. Univariate and multivariate analysis revealed that, use of laparoscopy was an independent protective factor for successful ERAS(OR: 0.33,95% CI = 0.22 ~ 0.47,P = 0.005), while pre-operative CRP level was an independent risk factor for failure of ERAS(OR: 3.97,95% CI = 3.26 ~ 4.35,P = 0.016). Conclusions: Application of ERAS program in patients with colon or high rectal cancer can promote postoperative recovery of bowel function, reduce postoperative hospital stay and ICU stay, and it can also reduce postoperative Clavien-Dindo I-II complications. Laparoscope method and preoperative CRP levels are related to the implementation of the ERAS program.更多还原