促进术后恢复综合方案在结直肠癌根治术中的应用

Application of the protocol of enhanced recovery after surgery in colorectal surgery

目的评价促进术后恢复综合方案（ERAS）在结直肠癌根治性手术中的作用。方法复旦大学附属中山医院普通外科结直肠专业组于2006年9月1日至2007年2月27日收治的符合人选标准的结直肠癌手术患者74例，被随机分为ERAS组和对照组。评价手术前后的应激指标、营养和代谢状况、术中肠道情况、术后恢复、并发症发生率、平均住院天数和住院费用。结果研究过程中，有6例中途出组。实际ERAS组34例，对照组34例；两组性别、年龄、BMI指数和结直肠原发疾病以及手术类型等具可比性。ERAS组胰岛素抵抗指数（HOMA—IR）变化幅度低于对照组，但各点的HOMA—IR指数差异无统计学意义（P〉0．05）；术中ERAS组胰高血糖素水平高于对照组（P〈0．05）；术后第1天皮质醇水平低于对照组（P〈0．05），血糖水平明显低于对照组（P〈0．05）；术中和术后第1、2天三酰甘油水平明显高于对照组（P〈0．05）。两组术前氮平衡差异无统计学意义（P〉0．05），手术当天和术后第6天ERAS组负氮平衡明显低于对照组（P〈0．05），但术后第2天ERAS组负氮平衡明显高于对照组，差异有统计学意义（P〈0．05）。ERAS组术后排气和排便时间、恢复进食时间、每天离床时间和活动时间、住院天数和并发症发生率等均明显好于对照组，差异有统计学意义（P〈0．05）。ERAS组手术后住院费用明显低于对照组（P〈0．05）。结论ERAS方案整合围手术期一系列干预措施，减少机体创伤应激反应．促进结直肠癌患者术后早日康复疗效显著；且安全可行，并可减少术后并发症的发生。

Objective To evaluate enhanced recovery after surgery（ERAS） protocol in colorectal surgery. Methods From september 2006 to February 2007, 74 patients with colorectal cancer were randomly assigned to ERAS group and control group. The stress index, nutrition and metabolism index, intraoperative index and postoperative index were evaluated. Results Six patients were excluded, 3 in ERAS group （2 cases received hepatectomy concomitantly and 1 case received partial ileum resection）, and 3 in control group （1 case received hepatectomy and 1 case received cholorectomy concomitantly, another presented asthma paroxysm）. So there were 34 cases in ERAS group and 34 cases in control, with no statistical differences in sex, age, BMI index and operation types. Deviation of HOMA-IR index of ERAS was lower than the control （P 〉 0.05）, the same as plasma cortisol at the 1st day after operation （P 〈 0.05）,but plasma glucagons in the operation of ERAS group was higher than that of control （P〈0.05）. Plasma glucose 1st day after operation of ERAS group was lower than control（P 〈 0.05）, while plasma triglyceride intraoperation, at 1st day, 2nd day after operation of ERAS was higher than control（P 〈 0.05 ）. Nitrogen negative balance of ERAS group was higher than control at 2nd day after surgery, but is lower intraoperation and at 6th day after operation（P 〈 0.05）. The time of exhaust gas and stool, time to eat fluidity and semi-fluidity, out-of-bed time and exercise time per-day, residual time and complication rate in ERAS group were better than those of control （P 〈 0,05）. Post-operative expenses of ERAS was lower than that of control （P 〈 0.05）. Conchmion ERAS can decrease surgical stress, increase functional recovery and reduce complication rate.