中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
10期
837-840
,共4页
胡金晨%胡三元%姜立新%张光永%郑海涛%吕忠船%郭吉田%陈红兵%吴国长%张翼飞
鬍金晨%鬍三元%薑立新%張光永%鄭海濤%呂忠船%郭吉田%陳紅兵%吳國長%張翼飛
호금신%호삼원%강립신%장광영%정해도%려충선%곽길전%진홍병%오국장%장익비
胃肿瘤%腹腔镜检查%胃切除术%加速康复外科
胃腫瘤%腹腔鏡檢查%胃切除術%加速康複外科
위종류%복강경검사%위절제술%가속강복외과
Stomach neoplasmas%Laparoscopy%Gastrectomy%Fast track surgery
目的 探讨在加速康复外科(fast track surgery,FTS)理念指导下,联合围手术期应用肠内营养,腹腔镜辅助远端胃癌根治术(laparoscopy assisted radical distal gastrectomy,LADG)的安全性及临床效果.方法 将61例远端胃癌患者随机分为3组:FTS+LADG组(19例)行LADG并应用FTS方案进行围手术期处理,LADG组(22例)行LADG,应用传统围手术期处理、FTS+开腹远端胃癌根治术(open distal gastrectomy,ODG)组(21例),即施行ODG并应用FTS方案进行围手术期处理.比较3组患者术后体质量、血清ALB、BUN、CRP、肠蠕动恢复时间、术后住院时间、住院费用、并发症发生等情况.结果 FTS +LADG组手术前后血清ALB水平高于FTS+ ODG组及LADG组,术后第4、7天FTS+ LADG组明显高于LADG组(P＜0.05、P＜0.01),术前至第4天血清ALB水平变化FTS+ LADG组、FTS+ODG组与LADG组间相比差异均具有统计学意义(均P＜0.01、均P＜0.05)；在术后第4、7天FTS+ LADG组血清CRP水平与FTS+ODG组之间相比差异均具有统计学意义(均P＜0.05)；FTS+ LADG组术后肠蠕动恢复时间明显快于LADG组、FTS+ ODG组(P＜0.05),FTS+ LADG组术后住院时间短于LADG组、FTS+ODG组,但差异无统计学意义(均P＞0.05),FTS+LADG组住院费用较LADG组明显低(P=0.003),但仍明显高于FTS+ ODG组(P＜0.01).3组均无吻合口漏等严重并发症,3组总的并发症发生率之间相比差异无统计学意义(P＞0.05).结论 FTS理念应用于腹腔镜辅助远端胃癌根治术可以改善患者的营养状态、减轻应激反应、促进胃肠道功能恢复、加速患者康复、缩短住院时间.
目的 探討在加速康複外科(fast track surgery,FTS)理唸指導下,聯閤圍手術期應用腸內營養,腹腔鏡輔助遠耑胃癌根治術(laparoscopy assisted radical distal gastrectomy,LADG)的安全性及臨床效果.方法 將61例遠耑胃癌患者隨機分為3組:FTS+LADG組(19例)行LADG併應用FTS方案進行圍手術期處理,LADG組(22例)行LADG,應用傳統圍手術期處理、FTS+開腹遠耑胃癌根治術(open distal gastrectomy,ODG)組(21例),即施行ODG併應用FTS方案進行圍手術期處理.比較3組患者術後體質量、血清ALB、BUN、CRP、腸蠕動恢複時間、術後住院時間、住院費用、併髮癥髮生等情況.結果 FTS +LADG組手術前後血清ALB水平高于FTS+ ODG組及LADG組,術後第4、7天FTS+ LADG組明顯高于LADG組(P＜0.05、P＜0.01),術前至第4天血清ALB水平變化FTS+ LADG組、FTS+ODG組與LADG組間相比差異均具有統計學意義(均P＜0.01、均P＜0.05)；在術後第4、7天FTS+ LADG組血清CRP水平與FTS+ODG組之間相比差異均具有統計學意義(均P＜0.05)；FTS+ LADG組術後腸蠕動恢複時間明顯快于LADG組、FTS+ ODG組(P＜0.05),FTS+ LADG組術後住院時間短于LADG組、FTS+ODG組,但差異無統計學意義(均P＞0.05),FTS+LADG組住院費用較LADG組明顯低(P=0.003),但仍明顯高于FTS+ ODG組(P＜0.01).3組均無吻閤口漏等嚴重併髮癥,3組總的併髮癥髮生率之間相比差異無統計學意義(P＞0.05).結論 FTS理唸應用于腹腔鏡輔助遠耑胃癌根治術可以改善患者的營養狀態、減輕應激反應、促進胃腸道功能恢複、加速患者康複、縮短住院時間.
목적 탐토재가속강복외과(fast track surgery,FTS)이념지도하,연합위수술기응용장내영양,복강경보조원단위암근치술(laparoscopy assisted radical distal gastrectomy,LADG)적안전성급림상효과.방법 장61례원단위암환자수궤분위3조:FTS+LADG조(19례)행LADG병응용FTS방안진행위수술기처리,LADG조(22례)행LADG,응용전통위수술기처리、FTS+개복원단위암근치술(open distal gastrectomy,ODG)조(21례),즉시행ODG병응용FTS방안진행위수술기처리.비교3조환자술후체질량、혈청ALB、BUN、CRP、장연동회복시간、술후주원시간、주원비용、병발증발생등정황.결과 FTS +LADG조수술전후혈청ALB수평고우FTS+ ODG조급LADG조,술후제4、7천FTS+ LADG조명현고우LADG조(P＜0.05、P＜0.01),술전지제4천혈청ALB수평변화FTS+ LADG조、FTS+ODG조여LADG조간상비차이균구유통계학의의(균P＜0.01、균P＜0.05)；재술후제4、7천FTS+ LADG조혈청CRP수평여FTS+ODG조지간상비차이균구유통계학의의(균P＜0.05)；FTS+ LADG조술후장연동회복시간명현쾌우LADG조、FTS+ ODG조(P＜0.05),FTS+ LADG조술후주원시간단우LADG조、FTS+ODG조,단차이무통계학의의(균P＞0.05),FTS+LADG조주원비용교LADG조명현저(P=0.003),단잉명현고우FTS+ ODG조(P＜0.01).3조균무문합구루등엄중병발증,3조총적병발증발생솔지간상비차이무통계학의의(P＞0.05).결론 FTS이념응용우복강경보조원단위암근치술가이개선환자적영양상태、감경응격반응、촉진위장도공능회복、가속환자강복、축단주원시간.
Objective To evaluate the safety and effectiveness of fast track surgery (FTS) in l aparoscopy-assisted radical distal gastrectomy (LADG) for gastric cancer.Methods Sixty-one patientswith distal gastric cancer were randomly divided into three groups:FTS + LADG group (n =19) undergoing LADG and FTS treatments,LADG group (n =22) undergoing LADG and traditional perioperative cares,and FTS + ODG ( open distal gastrectomy) group ( n =21 ) undergoing ODG and FTS treatments.FTS treatments included avoidance of mechanical bowel cleansing,restrictive perioperative intravenous infusion,early ambulation,early enteral nutrition.The age,sex,body weight,anastomotic mode,number of lymph node dissected,and tumor stage,serum albumin (ALB),blood urea nitrogen (BUN),C-reaction protein (CRP),flatus time,postoperative hospital stay,medical cost,and postoperative complications were compared between three groups. Results The level of ALB in FTS + LADG group were higher than in LADG group at the 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.01 ).Compared to LADG group,the variation of ALB from preoperation to 4th day after surgery in FTS + LADG group and FTS + ODG group was significant( P ＜ 0.01,P ＜ 0.05 ).CRP level between FTS + LADG group and FTS + ODG group were different significantly at 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.05).FTS + LADG group has earlier recovery of gastrointestinal peristalsis than other two groups ( P ＜ 0.05,P ＜ 0.05 ).The medical cost in FTS + LADG group was less than in LADG group ( P =0.003 ),but higher than in FTS + ODG group (P ＜0.01 ).Conclusions The practice of FTS in LADG was safe,effective,improves nutritional status,eases stress reaction,accelerates gastrointestinal peristalsis and postoperative rehabilitation.
