胃癌患者应用加速康复外科治疗的安全性及有效性研究

The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy

目的观察快速康复外科(FTS)治疗在胃癌手术患者中的安全性和有效性。方法 80例胃癌患者行 D2根治切除手术,分为两组,每组40例。传统对照组采用传统的围手术期处理方法;FTS 组采用 FTS 程序治疗,主要措施包括缩短患者术前的禁食时间,术前口服含碳水化合物的液体,不放置鼻胃减压管,使用生物蛋白胶封闭手术创面,不放置腹腔引流管,术后早期口服饮食,加强术后止痛,尽早下床活动等。观察比较两组手术及术后住院时间、营养状态、肠道功能、并发症发生及费用等情况。结果 FTS 组与传统对照组相比,术后住院时间缩短,治疗费用减少,术后肠排气时间提前,停止静脉输液时间提前,手术后体重下降减轻,以上指标两组差异均有统计学意义。FTS 组术后并发症的发生率并未增加。结论胃癌患者按 FTS 治疗安全、有效,可以减少住院时间与治疗费用,加速患者的康复。

Objective To investigate the safety and efficacy of fast track surgery management in gastric cancer undergoing D2 gastrectomy. Methods Eighty gastric cancer （FTS） patients undergoing D2 gastrectomy were recruited prospectively. Patients were assigned to receive FTS management （ n = 40） or conventional perioperative care （ n = 40）. The FTS care included shorten preoperative fasting time, no nasogastric decompressing tubes and abdominal drainage placed, early postoperative oral feeding, multimodal analgesia, and early mobilisation. The length of postoperative hospital stay, medical cost, nutritional status, gut function, and postoperative complications in the two groups were recorded and compared. Results FTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group[ （5.6 ± 1.3） d vs. （9.4 ± 1.9） d, P 〈 0. 05 ]. Medical cost was less [ （ 18 620 ± 2360 ） Yuan vs. （20 370 ± 2440） Yuan, P 〈 0. 05 ] and duration of intravenous infusion [ （3.5 ± 1.4） d vs. （5.8 ± 1.9） d, P 〈 0. 05 ] was also shorter. First passage of flatus was earlier in FTS group than in conventional care group[ （4. 3 ±0.4） d vs. （5.5 ±0. 9） d, P 〈0. 05 ]. Loss of body weight in the postoperative period was less in FTS group [ （3.2 ±0. 8） kg vs. （4.3 ± 1.6） kg,P 〈0. 05]. There was no difference in morbidity or mortality between the two groups. Conclusion FTS in D2 gastrectomy is safe and efficient, and it can shorten postoperative hospital stay and hasten return of gut function.