CAJ | 학술논문

目的：观察快速康复外科理念指导下的结直肠癌围手术期处理对患者临床结果的影响。方法将2011年9月至2012年10月间东南大学医学院附属徐州医院胃肠外科收治的需手术治疗的结直肠癌患者100例随机分为快速康复组及传统治疗组，每组50例，分别采用快速康复外科和传统方法进行围手术期处理，比较2组患者术后恢复情况、营养状况及并发症发生率。结果93例完成实验，其中快速康复组43例，传统治疗组50例，快速康复组与传统治疗组术后首次排气时间[（55．5±16．7）h比（69．3±20．1）h，P＜0．01]、排便时间[（66．1±10．4）h比（79．1±16．4）h，P＜0．01]、住院时间[（7．7±2．1）d比（9．6±2．7）d，P＜0．05]均有差异，且差异统计学意义；术后第5天快速康复组白蛋白及前白蛋白水平均高于传统治疗组，差异有统计学意义；快速康复组患者术后疼痛感受明显减轻；两组患者吻合口瘘、肺部感染、尿路感染、切口感染及腹泻等并发症的发生率无显著差异。结论快速康复外科理念指导下的结直肠癌围手术期处理安全有效，能有效减轻患者疼痛感受，促进肠道功能恢复，改善患者营养状况以及缩短住院时间。
목적：관찰쾌속강복외과이념지도하적결직장암위수술기처리대환자림상결과적영향。방법장2011년9월지2012년10월간동남대학의학원부속서주의원위장외과수치적수수술치료적결직장암환자100례수궤분위쾌속강복조급전통치료조，매조50례，분별채용쾌속강복외과화전통방법진행위수술기처리，비교2조환자술후회복정황、영양상황급병발증발생솔。결과93례완성실험，기중쾌속강복조43례，전통치료조50례，쾌속강복조여전통치료조술후수차배기시간[（55．5±16．7）h비（69．3±20．1）h，P＜0．01]、배편시간[（66．1±10．4）h비（79．1±16．4）h，P＜0．01]、주원시간[（7．7±2．1）d비（9．6±2．7）d，P＜0．05]균유차이，차차이통계학의의；술후제5천쾌속강복조백단백급전백단백수평균고우전통치료조，차이유통계학의의；쾌속강복조환자술후동통감수명현감경；량조환자문합구루、폐부감염、뇨로감염、절구감염급복사등병발증적발생솔무현저차이。결론쾌속강복외과이념지도하적결직장암위수술기처리안전유효，능유효감경환자동통감수，촉진장도공능회복，개선환자영양상황이급축단주원시간。
To investigate the clinical outcomes of perioperative management guided by the idea of fast track surgery in colorectal cancer.Methods A controlled randomized clinical trial was conducted from September 2011 to October 2012 in the department of Gastrointestinal Surgery, Xuzhou Hospital,Medical College of Southeast University.A total of 100 patients with colorectal cancer who would undergo elective operation were randomly divided into two groups:a fast-track group ( 50 cases ) and a conventional treatment group ( 50 cases ) .Clinical parameters, markers of nutrition and postoperative complications were recorded and evaluated in both groups postoperatively.Results Ninety three patients eventually completed the study,43 cases in fast-track group and 50 cases in conventional treatment group.As compared to the conventional treatment group, the first postoperative time of flatus of fast-track group was significantly shorter in the fast-track group[(55.5 ±16.7)h vs.(69.3 ±20.1)h,P<0.01],as were the first passage of stool[(66.1 ±10.4)h vs.(79.1 ±16.4)h,P<0.01]and the length of stay[(7.7 ±2.1)d vs.(9.6 ±2.7)d,P<0.05].The levels of albumin and prealbumin were significant higher in the fast-track group as compared to the conventional treatment group on postoperative day 5.The patients of fast-track group felt less pain after operations.The differences of anastomotic leakage, pulmonary infection, urinary tract infection,wound infection and diarrhea were not statistically significant between the two groups(P>0.05). Conclusions Perioperative management guided by the idea of fast track surgery in colorectal cancer was safe and effective, can effectively reduce the pain, promote the intestinal function recovery, improve the nutritional status and reduce the time in hospital.