快速流程模式下术后限制补液对不同手术方案直肠癌患者康复情况的影响

Clinical Effects of Different Strategies for Surgical Treatment of Rectal Cancer Patients Combined with Restrict Rehydration in Fast-Track

目的比较快速流程模式下不同手术方案联合术后限制补液策略对直肠癌患者术后康复情况的影响。方法回顾性研究2008年1月至2009年1月期间四川大学华西医院肛肠外科专业组收治的直肠癌患者的临床资料,分析比较术后不同补液策略联合不同手术方案〔高位前切除术(HAR)、低位/超低位前切除术(LAR)〕综合治疗的直肠癌患者术后康复情况。结果从术后康复指标看,常规补液组的术后排气、排便、进食及下床活动时间均长于限制补液组(P<0.05);常规补液组中LAR组的术后排气、排便及进食时间均长于HAR组(P<0.05);限制补液组中LAR组与HAR组其术后早期恢复指标间的差异则无统计学意义(P>0.05)。从术后并发症的发生率上看,常规补液组的肺部感染、伤口感染和肠梗阻发生率均高于限制补液组(P<0.05);常规补液组中LAR和HAR组间的术后并发症发生率差异无统计学意义(P>0.05);限制补液组中LAR和HAR组间的术后早期恢复和并发症发生率的差异无统计学意义(P>0.05)。结论不同部位的直肠癌切除术后采取限制补液策略是可行的,能促使患者的早期康复。

Objective To compare the clinical effect of different strategies for surgical treatment combined with restrict rehydration on rehabilitation of rectal cancer patients in fast-track. Methods From January 2008 to January 2009,the patients diagnosed definitely as rectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different surgical programs 〔high anterior resection （HAR）,low anterior resection （LAR）〕. Results The difference of first aerofluxus,first defecation,postoperative first eating and first ambulation between fluid restriction group and tradition therapy group was statistically significant （P0.05）. And the difference of first aerofluxus,first defecation and post-operative first eating between HAR group and LAR group in tradition therapy group was statistically significant （P0.05）. Regarding to the overall incidence of postoperative complications,the incidence of pulmonary infection,wound infection and intestinal obstruction in tradition therapy group were higher than that in fluid restriction group （P0.05）. And in tradition therapy group,the difference in the incidence of intestinal obstruction between LAR group and HAR group was not statistically significant （P0.05）. The difference of early recovery and postoperative complications between HAR group and LAR group in fluid restriction group had no statistical significance （P0.05）. ConclusionDifferent strategies for surgical treatment of rectal cancer patients combined with restrict rehydration in fast-track is feasible and can promote early rehabilitation of patients.