结直肠外科快速康复模式加速直肠癌术后康复的临床研究

Perioperative fast track programs enhance the postoperative recovery after rectal carcinoma resection

目的评价结直肠外科快速康复模式（FT）对加速直肠癌手术患者术后康复的作用。方法将83例直肠癌择期手术病例随机分为2组，围手术期管理分别接受快速康复模式（即简化肠道准备、手术前夜允许进普通饮食、术后不待肛门排气即拔除胃管并恢复饮食、术后强制早期活动、不常规放置引流管及早期拔除尿管等；FT组，44例）和传统模式（对照组，39例），记录两组患者的术后住院时间、30d内手术并发症和再入院率并作统计学分析。结果两组患者性别、术式、合并症、肿瘤TNM分期等变量的构成比及年龄、手术时间、失血量等计量资料比较，差异均无统计学意义（P〉0．05）。FT组术后平均住院时间（4．7±2．6）d，较对照组的（8．9±2．8）d显著缩短（P〈0．01）；其术后30d内并发症发生率也明显低于对照组（P〈0．05）；再入院率两组比较P=0．326．FT组未见升高。结论结直肠外科快速康复模式用于择期直肠癌围手术期临床管理，可加速患者的康复。

Objective To evaluate the effect of the fast track programs （FT） on the postoperative recovery of patients with rectum carcinoma after rectal cancer resection. Methods Eighty- three patients, undergone elective rectal carcinoma resection in our hospital, were randomly divided into two groups. FT group （44 cases） received the perioperative FT programs care, including bowel preparation reduction, preoperative normal intake, early removal of the nasogastrie tube and bladder catheter, early postoperative feeding, early mobilization, and no routine drainage. Control group （39 cases） received the conventional program care. The postoperative hospital stay, surgical complications and readmission rate within 30 days postoperatively were compared between the two groups. Results The data of two groups such as gender, surgical procedures, complications, TNM stage of tumor, age, operation time and intra-operative blood loss were similar. The mean postoperative hospital stay in FF group was significantly shorter than that in control group[ （4.7-＋2.6） d vs（8.9＋2.8） d] （P〈 0.001 ）. The surgical complications within 30 days postoperatively in FF group were significantly less than those in control group （P〈0.05）. The difference of readmission rate was not significant between the two groups （P=0.326）. Conclusion The colorectal surgical fast track programs applied to the perioperative period care of rectal carcinoma resection can decrease the hospital stay and surgical complications with no obvious change in readmission rate, so the postoperative recovery of patients with rectal carcinoma resection can be improved.