【摘要】 目的探讨快速康复外科(FTS)在肝癌围手术期应用的可行性,为临床提供参考和依据。方法选取2010年11月1日至2013年3月31日肝癌切除病例40例,采用区组随机化将患者分为两组(快速康复组和传统治疗组),每组各20例,进行前瞻性随机对照研究。比较两组术前、术后临床监测指标、肠道功能恢复情况;术前术后肝酶学和白蛋白、前白蛋白、血糖等营养代谢指标以及并发症、再入院率、死亡率,统计白蛋白总使用量、平均营养费用和总住院时间。结果两组术前一般资料无统计学差异。术后快速康复组首次排气时间、排便时间、耐受半流质时间较传统治疗组明显缩短[(44.5±8.3)h vs.(68.6±10.4)h、(74.3±15.6)h vs.(112.4±14.9)h、(85.2±16.5)h vs.(117.1±25.0)h,均P<0.05],术后第7天血清白蛋白、前白蛋白明显高于传统治疗组[(36.6±5.7)g/L vs.(31.5±5.3)g/L、(182.3±58.5)mg/L vs.(144.2±60.3)mg/L,均P<0.05]。两组之间总并发症无统计学差异,而快速康复组的感染性并发症明显降低(0/20 vs.2/20)。术后两组白蛋白用量相当,而快速康复组平均营养费用和住院时间均明显低于传统治疗组[(235.8±73.5)元vs.(354.2±76.0)元、(9.8±9.2)d vs.(15.5±11.7)d,均P<0.05]。结论肝癌围手术期应用FTS的初步尝试是可行的,可以促进患者早日康复,减少医疗费用,节省医疗资源。更多还原

【Abstract】 Objective To study the feasibility of fast track surgery in the peri-operation period of hepatocellular carcinoma. Methods 40 hepatectomy cases of hepatocellular carcinoma from November 1, 2010 to March 31, 2013, were divided into two groups(fast track surgery group and conventional treatment group) by using block randomization for the prospective randomized controlled study. Each group had 20 cases. The clinical data including preoperational and post operational clinical monitoring indexes, intestinal function recovery, liver enzymology, albumin, pre albumin, blood glucose value, complications, mortality, readmission rate, albumin consumption, cost of nutrition and total hospitalization time were compared and analyzed by statistics. Results There were no significant difference in the general data between two groups of patients before operation. The first exhaust time, defecation time, semi fluid tolerance time in the postoperative seventh days, the serum albumin, prealbumin of fast track surgery group were significantly higher than traditional treatment group. There was no difference of the total complications between the two groups, while the infectious complications of fast track surgery were significantly lower than traditional treatment group. The albumin consumption was equal in two groups, but the average hospitalization time and total expenses of fast track surgery were significantly lower than that of traditional treatment group. Conclusion It is effective and safety of fast track surgery for the preliminary trial and application in the peri operation period of hepatocellular carcinoma, which indicates that fast track surgery could promote early recovery of patients and reduce medical costs, so as to save the medical resources.更多还原