【摘要】 目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念应用于腹腔镜辅助远端胃癌D2根治术患者围术期的安全性与有效性。方法回顾性分析2016年5月至2018年12月福建省立医院腹腔镜辅助远端胃癌D2根治术患者369例,其中156例应用ERAS模式行围术期处理(ERAS组),213例行传统围术期处理(传统组),对两组患者手术情况及术后恢复情况进行对比分析。结果 ERAS组手术时间(196.68±48.65)min略短于传统组(204.92±54.00)min,但两组相比无明显统计学差异,而 ERAS组首次排气时间45(38)h短于传统组57(11)h(Z=-5.10,P<0.05),腹腔引流管留置时间5(2)d短于传统组7(1)d(Z=-10.54,P<0.05),术后住院天数6(2)d短于传统组8(2)d(Z=-8.78,P<0.05),住院费用(6.32±0.76)万元低于传统组(6.59±1.12)万元(t=-2.58,P=0.01),差异均有统计学意义;ERAS组非计划再入院患者14例,传统组9例,两组相比差异无统计学意义;ERAS组肺部感染7例少于传统组23例(χ~2=4.80,P=0.03),差异有统计学意义,腹腔积液、腹泻、吻合口瘘、吻合口出血、十二指肠残端瘘、急性尿潴留、切口感染、胃瘫、肠梗阻、泌尿系感染方面,两组相比差异无统计学意义。结论 ERAS应用于腹腔镜辅助远端胃癌D2根治术患者围术期是安全有效的。更多还原

【Abstract】 Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) in perioperative period of patients who received laparoscopic-assisted D2 radical distal gastrectomy for gastric cancer.Methods A retrospective analysis was conducted on 369 patients who had received laparoscopic-assisted D2 radical distal gastrectomy for gastric cancer in our hospital from May 2016 to December 2018,including 156 patients who received ERAS perioperative management (ERAS group),and the other 213 patients who received conventional perioperative management (conventional group).Comparison of surgical situation and postoperative recovery of the two group patients were performed.Results The operation time in the ERAS group was (196.68±48.65) min,slightly shorter than (204.92±54.00) min in the conventional group,but there was no statistically significant difference between the two groups.However,the first exhaust time in the ERAS group was 45(38)h,shorter than 57(11)h in the conventional group(Z=-5.10,P<0.05);the indwelling time of the abdominal drainage tube in the ERAS group was 5(2)d,shorter than 7(1)d in the conventional group(Z=-10.54,P<0.05);the postoperative hospital stay in the ERAS group was 6(2)d,shorter than 8 (2)d in the conventional group(Z=-8.78,P<0.05);the hospitalization costs in the ERAS group was (63.2±7.6) thousand yuan,shorter than (65.9±11.2) thousand yuan of in conventional group (t=-2.58,P=0.01) with significant differences.The unscheduled re-admission cases in the ERAS group was 14,compared with 9 in the conventional group with no significant difference;the pulmonary infection cases in the ERAS group was 9,less than 23 in the conventional group(χ~2=4.80,P=0.03) with significant difference.While the rates of ascites,diarrhea,anastomotic leakage,anastomotic bleeding,duodenal stump fistula,acute urinary retention,incision infection,gastroparesis,intestinal obstruction and urinary tract infection were not significantly different between the two groups.Conclusion ERAS is safe and effective in perioperative period of patients who received laparoscopic-assisted D2 radical distal gastrectomy for gastric cancer.更多还原