【作者】 罗德胜； 徐宏涛； 章平禄； 胡平； 曹海波； 郑晶晶；

【机构】 丽水市中心医院胃肠外科；

【摘要】 目的 :分析和探讨加速康复外科对腹腔镜胃癌根治术患者的临床效果。方法 :选取2016年6月至2017年12月在我院行腹腔镜胃癌根治术治疗患者160例,采用随机数表法将患者分为两组,ERAS组80例,给予加速康复外科理念围术期管理,传统组80例,给予常规治疗。比较两组患者一般情况、吻合方式、肿瘤分期、手术时间、术中失血量、术后并发症情况、疼痛评分、术后首次肛门排气时间、术后炎症指标(包括白细胞(WBC)、C-反应蛋白(CRP)、血清淀粉样蛋白A(SAA))、术后血清蛋白值(前白蛋白及白蛋白)和术后住院时间、住院费用。术后并发症为根据Claviend Dindo手术并发症分级系统的定义和分级。同时对两组患者的治疗结果进行比较。结果:ERAS组患者的住院时间(6.52±2.41d)、肛门排气时间(2.98±0.56d)短于传统组(9.89±3.69d、3.79±1.43d),ERAS组的住院费用较传统组更少(4.35±0.75 VS 5.98±0.83万元),两组比较均有统计学意义(P<0.05)。ERAS组患者术后12h、24h及48h的疼痛评分与传统组对比均较低(3.34±1.27 vs 5.17±1.35;2.71±0.92 vs 5.72±2.71;1.98±0.75 vs 4.62±1.69),比较均有统计学意义(P <0.05);ERAS组患者在术后1d、3d、5d检测的血清前白蛋白值和血清白蛋白值较传统组均高,比较有统计学意义(P<0.05)。ERAS组在手术时间、术中失血量、淋巴结清扫数量、术后总并发症发生率、术后炎症指标与传统组比较差异均无统计学意义(P>0.05);结论:腹腔镜胃癌根治术围术期给予加速康复外科理念管理是安全可行的,它可以改善患者营养状况,加快患者的胃肠功能恢复,缩短平均住院日,减少住院费用,减轻患者术后疼痛,使患者获益。更多还原

【Abstract】 Objective To analyze and explore the clinical effect of enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer.Methods 160 patients who underwent laparoscopic radical gastrectomy for gastric cancer patients from June 2016 to December 2017 in our hospital,randomly divided the patients into two groups,80 cases in the ERAS group,given the enhanced recovery after surgery nursing,80 cases in Traditional group were given routine nursing intervention.The general condition,anastomosis mode,tumor stage,operation time,blood loss during operation,postoperative complications,pain score,first anal exhaust time after operation,Postoperative inflammatory indexes(including WBC,C-reactive protein,Serum amyloid A protein),postoperative serum protein values(prealbumin and albumin),postoperative hospitalization time and hospitalization cost were compared between the two groups.and the follow-up results of the two groups were compared.The results of treatment were compared between the two groups.Results Hospitalization time of ERAS group patients(6.52±2.41d),anal exhaust time(2.98+ 0.56d) shorter than the traditional group(9.89 + 3.69d,3.79 + 1.43d),ERAS group hospitalization costs were less than those of traditional group,the difference was significant(P < 0.05).The pain scores in ERAS group were significantly lower than those in the traditional group at 12h,24h and 48h after operation(P < 0.05).The serum prealbumin and serum albumin levels in the ERAS group were higher than those in the traditional group on the 1st,3rd and 5th day after operation(P < 0.05).In ERAS group,there was no significant difference in operation time,blood loss during operation,lymph node dissection,total postoperative complications and postoperative inflammatory index(P > 0.05).Conclusion It is safe and feasible to give the management of enhanced recovery after surgery in the perioperative period of laparoscopic radical gastrectomy for gastric cancer.It can improve the nutritional status of the patients,accelerate the recovery of gastrointestinal function,shorten the average hospital stay,and reduce the cost of hospitalization,relieve postoperative pain and benefit patients.更多还原