国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2012年
11期
737-741
,共5页
白明东%徐海%刘先武%赵严冬
白明東%徐海%劉先武%趙嚴鼕
백명동%서해%류선무%조엄동
胃肿瘤%外科手术%康复%快速通道外科
胃腫瘤%外科手術%康複%快速通道外科
위종류%외과수술%강복%쾌속통도외과
Stomach neoplasms%Surgical procedures,operative%Rehabilitation%Fast track surgery
目的 回顾性分析实施快速通道外科程序前后胃癌患者的临床疗效和恢复情况.方法 130例接受择期开放性胃癌手术且无并发症发生的胃癌患者纳入本研究,根据快速通道外科实施与否分为传统处理组(n=65)和快速通道外科组(n=65).对两组患者术后饮食、液体输入、恢复活动、术后住院时间和出院后康复情况进行回顾性分析.结果 快速通道外科组术后开始活动、进流食和固体食物时间和停止静脉输液时间均优于传统处理组[0.3(0～1)d vs 3.3(2～4)d,0.2(0～1) d vs 3.5(3～4)d,3.3(3 ～4) d vs 5.6(5～6)d,3.4(3 ～4)d vs 5.2(5 ～6)d；均P=0.000],前者术后住院时间也明显缩短[6.6(6 ～8)d vs 8.6(8 ～9)d,P=0.000].两组工具性日常生活活动于术后14 d均有所减少,但传统处理组术前活动水平更高,其减幅更大[5.0(3～6) vs 3.0(3 ～5),4.0(3 ～6) vs 3.0(3～5);均P=0.000].两组术前疲劳强度相似,出院后14 d传统处理组明显增高,但在30 d时恢复到正常水平[2.0(1～5) vs 3.0(1 ～5),2.0(1～5) vs 2.0(1～6)；P=0.005,P=0.065].传统处理组术后14 d时总睡眠时间明显长于术前[9.0(6～11) h vs 8.0(5～10)h,P=0.000],而快速通道外科组则无明显变化[8.0(5 ～ 11)h vs 8.0(6 ～ 10)h,P=0.327].结论 快速通道外科程序能减少术后应激并加速择期及无手术并发症发生的胃癌患者的康复过程.
目的 迴顧性分析實施快速通道外科程序前後胃癌患者的臨床療效和恢複情況.方法 130例接受擇期開放性胃癌手術且無併髮癥髮生的胃癌患者納入本研究,根據快速通道外科實施與否分為傳統處理組(n=65)和快速通道外科組(n=65).對兩組患者術後飲食、液體輸入、恢複活動、術後住院時間和齣院後康複情況進行迴顧性分析.結果 快速通道外科組術後開始活動、進流食和固體食物時間和停止靜脈輸液時間均優于傳統處理組[0.3(0～1)d vs 3.3(2～4)d,0.2(0～1) d vs 3.5(3～4)d,3.3(3 ～4) d vs 5.6(5～6)d,3.4(3 ～4)d vs 5.2(5 ～6)d；均P=0.000],前者術後住院時間也明顯縮短[6.6(6 ～8)d vs 8.6(8 ～9)d,P=0.000].兩組工具性日常生活活動于術後14 d均有所減少,但傳統處理組術前活動水平更高,其減幅更大[5.0(3～6) vs 3.0(3 ～5),4.0(3 ～6) vs 3.0(3～5);均P=0.000].兩組術前疲勞彊度相似,齣院後14 d傳統處理組明顯增高,但在30 d時恢複到正常水平[2.0(1～5) vs 3.0(1 ～5),2.0(1～5) vs 2.0(1～6)；P=0.005,P=0.065].傳統處理組術後14 d時總睡眠時間明顯長于術前[9.0(6～11) h vs 8.0(5～10)h,P=0.000],而快速通道外科組則無明顯變化[8.0(5 ～ 11)h vs 8.0(6 ～ 10)h,P=0.327].結論 快速通道外科程序能減少術後應激併加速擇期及無手術併髮癥髮生的胃癌患者的康複過程.
목적 회고성분석실시쾌속통도외과정서전후위암환자적림상료효화회복정황.방법 130례접수택기개방성위암수술차무병발증발생적위암환자납입본연구,근거쾌속통도외과실시여부분위전통처리조(n=65)화쾌속통도외과조(n=65).대량조환자술후음식、액체수입、회복활동、술후주원시간화출원후강복정황진행회고성분석.결과 쾌속통도외과조술후개시활동、진류식화고체식물시간화정지정맥수액시간균우우전통처리조[0.3(0～1)d vs 3.3(2～4)d,0.2(0～1) d vs 3.5(3～4)d,3.3(3 ～4) d vs 5.6(5～6)d,3.4(3 ～4)d vs 5.2(5 ～6)d；균P=0.000],전자술후주원시간야명현축단[6.6(6 ～8)d vs 8.6(8 ～9)d,P=0.000].량조공구성일상생활활동우술후14 d균유소감소,단전통처리조술전활동수평경고,기감폭경대[5.0(3～6) vs 3.0(3 ～5),4.0(3 ～6) vs 3.0(3～5);균P=0.000].량조술전피로강도상사,출원후14 d전통처리조명현증고,단재30 d시회복도정상수평[2.0(1～5) vs 3.0(1 ～5),2.0(1～5) vs 2.0(1～6)；P=0.005,P=0.065].전통처리조술후14 d시총수면시간명현장우술전[9.0(6～11) h vs 8.0(5～10)h,P=0.000],이쾌속통도외과조칙무명현변화[8.0(5 ～ 11)h vs 8.0(6 ～ 10)h,P=0.327].결론 쾌속통도외과정서능감소술후응격병가속택기급무수술병발증발생적위암환자적강복과정.
Objective To investigate the clinical outcome before and immediately after implementation of fast track surgery protocol on patients with gastric cancer.Methods One hundred and thirty patients with gastric cancer in our hospital underwent an elective,uncomplicated,open gastric surgery before (Traditional care group,n =65) and immediately after implementing fast track surgery (Fast track surgery group,n =65).Postoperative food and fluid intake,mobilization,length of hospital stay,and clinical outcome were recorded and analysed,and a interview-based assessment was performed on days 14 and 30 postoperatively.Results Patients implemented fast track surgery were associated with a significantly earlier resumption of mobilization and oral fluids and normal diet,shorter duration of intravenous infusion compared with traditional care patients 0.3 (0-1) d vs 3.3 (2-4) d,0.2(0-1) d vs 3.5(3-4) d,3.3(3-4) d vs 5.6(5-6) d,3.4(3-4) d vs 5.2(5-6) d; P=0.000,respectively.Postoperative hospital stay was also shorter in fast track surgery group 6.6 (6-8) d vs 8.6 (8-9) d ; P =0.000.Instrumental activities of daily living decreased in both groups on day 14,but significantly more in the traditional care group,despite having a higher preoperative instrumental activities of daily living level compared with the fast track surgery group 5.0 (3-6) vs 3.0 (3-5),4.0 (3-6) vs 3.0 (3-5) ; P =0.000,respectively.Preoperative fatigue score was not different between two groups,but the fatigue score was significantly increased on day 14,and returned to normal value on day 30 in the traditional care group 2.0 (1-5) vs 3.0 (1-5),2.0(1-5) vs 2.0(1-6) ; P =0.005,P =0.065.Total length of sleep on day 14 was increased significantly in the traditional care group,but not changed in the fast track surgery group compared with preoperative value 9.0 (6-11) vs 8.0(5-10) h,8.0(5-11) vs 8.0(6-10) h; P=0.000,P=0.327.Conclusions A fast track surgery protocol can lessen postoperative stress reactions and enhance recovery for patients with gastric cancer undergoing an elective,uncomplicated,open resection.
