加速康复外科技术在胃癌围手术期应用的初步观察

Observation of fast track surgery in patients with gastric cancer

目的观察加速康复外科技术在胃癌患者围手术期治疗过程中的应用情况。方法使用计算机产生随机数字，完全随机将92例胃癌患者分为常规对照组（46例，采用常规围手术期处理方案）和加速康复组（46例，采用加速康复的围手术期处理方案）。动态监测比较两组术后第1、3、7天血清白介素。6（IL-6）和肿瘤坏死因子-α（TNF-α）及C反应蛋白（CRP）水平，同时应用间接能量测定仪测定患者静息能量消耗（REE）和记录患者术后并发症及住院天数并进行比较。结果加速康复组和常规对照组术后第1、3天的IL-6分别为（112．52±24．73）ng／L和（123．90±22．52）ng／L、（129．03±22．75）ng／L和（142．67±20．33）ng／L；TNF-α分别为（12.67±2．68）fmmol／L和（14．74±3．18）fmmol／L、（13．19±2．75）fmmol／L和（15．56±2．99）fmmol／L，前者明显低于后者（P〈0．05）。术后第1、3、7天的CRP两组分别为（56．20±11．47）g／L和（71．07±17．32）g／L、（136．09±19．78）g／L和（157．78±28．18）g／L、（48．53±12．95）g／L和（64．72±19．73）g／L，前者仍明显低于后者（P〈0．05）。加速康复组患者术后第1、3天REE分别为（5713．96±619．44）kJ／d和（5298．49±639．36）kJ／d，明显低于常规对照组的（6176．04±614．46）kJ／d和（5627．94±656．72）kJ／d（P〈0．05）。加速康复组患者和常规对照组的术后发热时间分别为2（2．0～3．0）d和4（2．8～4．0）d；排气时间分别为3（2．0．4．0）d和4（3．8-5．0）d；术后住院天数分别为6（6．0～7．0）d和8（7．0～8．3）d；治疗费用分别为人民币（27201±3857）元和（31006±3555）元：前者均明显低于后者（P〈0．01）。术后并发症发生率两组差异无统计学意义（P〉0．05）。加速康复组患者出院时生活质量评分15．74±1．82，明显高于对照组的14．67±1．27（P〈0．01）。结论加速康复外科技术能够减轻胃癌患者围手术期间的应激反应，减少术后机体静息能量消耗，加速胃癌患者的康复。

Objective To investigate the effects of fast track surgery on patients with gastric cancer in perioperative period. Methods Ninety-two patients with gastric cancer undergone radical operations were randomly divided into two groups： fast track group （n=46, fast track surgery） and control group （n =46, traditional surgery）. Serum levels of tumor necrosis factor-α （TNF-α）, interleukin-6（IL-6） and C reaction protein （CRP） in the 92 patients were assayed preoperatively and at day 1, 3, 7 postoperatively, and the resting energy expenditure（REE） was also measured by indirect calorimetry in the morning. The postoperative hospital stay, duration of fever, medical cost, postoperative time of flatus and postoperative complications were recorded and compared respectively. Results At postoperative day 1 and 3, serum levels of TNF-α were （12.67±2.68） fmmol/L and （ 13.19±2.75 ） fmmol/L in fast track group, （ 14.74±3.18 ） fmmol/L and （15.56±2.99） fmmol/L in control group; serum levels of IL-6 were （112.52±24.73） ng/L and （129.03±22.75） ng/L in fast track group, （123.90±22.52） ng/L and （142.67±20.33） ng/L in control group. The levels of IL-6 and TNF-α in fast track group were significantly lower than those in control group （all P〈0.05）. At postoperative day 1, 3 and 7, serum levels of CRP in fast track group were significantly lower than those in control group [d1（56.20±11.47） g/L vs （71.07±17.32） g/L, d3（136.09±19.78） g/L vs （157.78±28.18） g/L, d7 （48.53±12.95） g/L vs （64.72±19.73） g/L] （all P〈0.05）. At postoperative day 1 and day 3, the REE in fast track group were significantly lower those than in control group[dl（5713.96±619.44） kJ/d vs （6176.04±614.46） kJ/d, d3 （5298.49±639.36） kJ/d vs （5627.94±656.72） kJ/d] （all P〈0.05）. The postoperative duration of fever [ 2 （2.0-3.0） d vs 4 （2.8-4.0） d ], postoperative time of flatus [ 3 （2.0-4.0） d vs 4 （3.8-5.0） d], postoperative hospital stay [6 （6.0-7.0） d vs 8 （7.0-8.3） d] and treatment expense [ （27 201±3857） Chinese yuan vs （31 006±3555） Chinese yuan] in fast track group were also significantly lower than those in control group（P〈0.01 ）. There were no significant differences in complications between the two groups （P〉0.05）. The quality of life score on discharge in fast track group was significantly higher than that in control group （15.74±1.82 vs 14.67±1.27, P〈0.01）. Conclusion Fast track surgery can ameliorate stress reaction, decrease postoperative patients＇ REE during perioperative period and accelerate the rehabilitation of patients with gastric cancer.