【作者】 刘伟；

【导师】 刘振忠；

【作者基本信息】 泰山医学院 ， 外科学（专业学位）， 2017， 硕士

【摘要】 目的:探讨分析腹腔镜直肠癌手术患者采用快速康复外科治疗模式的临床效果和安全性。方法:选取2014年12月至2016年12月在泰山医学院附属医院普外科同一组医护人员进行腹腔镜手术的42例直肠癌患者,被选入组的所有患者已通过影像学检查、结肠镜检查及组织病理活检确诊为直肠癌,且所有患者可采用腹腔镜根治术进行治疗,患者依据围手术期康复方案的不同分为观察组(n=22)、对照组(n=20),观察组患者围手术期采用快速康复外科模式,对照组患者采用传统康复模式(为本科室同一组在未引入FTS前随机选择的患者)。观察并对比两组患者一般资料(包括性别、年龄、BMI、肿瘤组织学分型和肿瘤分型)、患者术后恢复情况(包括首次排气时间、胃管拔除时间、引流管拔除时间、首次经口进食时间、术后住院时间和治疗费用)、患者手术前后营养状况(包括术前和术后7天血清血红蛋白、前白蛋白和白蛋白水平)、手术后炎症反应和应激反应情况(包括白细胞水平、IL-6和血糖水平)以及术后并发症发生情况(如切口感染、吻合口瘘、腹腔感染、术后肠梗阻、肺部感染以及尿路感染等)。结果:通过对比,两组在多项一般资料方面无显著统计学差异(P>0.05);观察组患者首次排气时间(t=5.59,P<0.05)、胃管拔除时间(t=6.21,P<0.05)、引流管拔出时间(t=4.96,P<0.05)、首次经口进食时间(t=6.24,P<0.05)和术后住院时间(t=6.17,P<0.05)明显比对照组短;观察组患者治疗的费用明显少于照组(t=3.83,P<0.05);手术前,两组患者血红蛋白(t=1.25,P>0.05)、前白蛋白(t=0.84,P>0.05)和白蛋白(t=1.08,P>0.05)水平没有显著统计学差异;手术后,观察组血红蛋白(t=7.31,P<0.05)、前白蛋白(t=5.70,P<0.05)和白蛋白(t=6.22,P<0.05)水平明显比对照组高;手术前,两组患者白细胞(t=0.77,P>0.05)、IL-6(t=0.98,P>0.05)和血糖(t=1.13,P>0.05)水平没有显著统计学差异;手术后1天,观察组患者白细胞(t=6.24,P<0.05)、IL-6(t=7.08,P<0.05)和血糖(t=6.46,P<0.05)水平明显比对照组低;观察组术后并发症发生情况明显优于对照组(χ~2=6.34,P<0.05)。结论:快速康复外科治疗模式在腹腔镜直肠癌根治术临床应用效果显著,术后患者应激反应、炎症反应较轻,术后营养水平较高,且出现术后并发症的可能性低,术后恢复较快,患者可尽早出院,减轻患者的经济压力,临床应用价值较高。更多还原

【Abstract】 Objective:To explore the clinical effect of rapid rehabilitation surgery in the operation of laparoscopic rectal cancer.Method:Forty-two patients undergoing laparoscopic surgery for rectal cancer under the same treatment group in the Department of General Surgery of the Affiliated Hospital of Taishan Medical College from December 2014 to December 2016 were selected.All patients who were enrolled in the study had been diagnosed with rectal cancer by imaging examination,colonoscopy and biopsy and colon(n=22)and the control group(n=20).The patients in the control group were treated with traditional laparoscopic radical resection of rectal cancer.The patients in the observation group were treated with the same group of patients with rectal cancer.Using rapid rehabilitation surgery combined with laparoscopic radical resection of rectal cancer for treatment.(Including sex,age,BMI,tumor histological type and tumor type),postoperative recovery of the patients(including the first exhaust time,the extraction time of the gastric tube,the drainage tube extraction time,the first oral feeding time,the postoperative hospital stay and the treatment cost),the nutritional status of patients before and after operation(including preoperative and postoperative 7 days of peripheral venous blood serum hemoglobin,prealbumin and albumin levels),postoperative inflammatory response and stress response(including leukocyte levels,IL-6 and blood glucose levels)and postoperative inflammatory res and postoperative complications(such as incision infection,anastomotic leakage,abdominal infection,postoperative intestinal obstruction,pulmonary infection,urinary tract infection,etc).Results:There was no statistically significant difference in the number of general information by comparing the aspect(P>0.05);the patients in the observation group were the extubation time(t=6.21,P<0.05),first exhaust time(t=5.59,P<0.05),the drainage tube pulled out of time(t=4.96,P<0.05),the first time of oral intake(t=6.24 P<0.05),hospitalization time and postoperative(t=6.17,P<0.05)was significantly shorter than the control group;The cost of treatment of patients in the observation group(t=3.83,P<0.05)was significantly lower than the control group;before the surgery,two groups of patients with hemoglobin(t=1.25,P>0.05),prealbumin(t=0.84,P>0.05)and albumin(t=1.08,P>0.05)is not significant statistical difference;after the surgery,the observation group of hemoglobin(t=7.31,P<0.05),prealbumin(t=5.70,P<0.05)and albumin(t=6.22,P<0.05)was significantly higher than the control group;before the surgery,patients in the two groups of white blood cells(t=0.77,P>0.05),IL-6(t=0.98,P>0.05)and blood glucose(t=1.13,P>0.05)the level of No significant difference;1 days after the surgery,the observation group of white blood cells in patients with(t=6.24,P<0.05),IL-6(t=7.08,P<0.05)and blood glucose(t=6.46,P<0.05)was significantly lower than the control group;the control group of patients with postoperative complication rate was significantly higher than the observation group(χ~2=6.34,P<0.05).Conclusion:The treatment mode of rapid rehabilitation surgery in laparoscopic radical resection of rectal cancer has significant clinical effect,postoperative stress reaction,inflammatory reaction is lighter,higher level of nutrition after operation,and the possibility of postoperative complications is low,rapid recovery after operation,patients can be discharged as soon as possible,reduce the patient’s economic pressure,the higher the value of clinical application.更多还原