加速康复外科联合腹腔镜应用于结直肠癌手术的临床研究

Application of laparoscopic surgery with fast track rehabilitation in colorectal surgery

目的 探讨加速康复外科（fast track surgery,FTS）联合腹腔镜技术作为常规应用于结直肠手术的安全性及有效性.方法 回顾性分析我院自2004年6月至2010年10月期间由同一手术组完成的结直肠癌手术病例：传统围手术期处理的对照开腹手术108例（Ⅰ组）,FTS理念指导下的开腹手术158例（Ⅱ组）,FTS理念指导下腹腔镜辅助结直肠手术137例（Ⅲ组）,比较三组患者各项临床指标.结果 Ⅲ组与Ⅰ组、Ⅱ组相比,术中出血量明显降低、切口长度减少、术后下床时间缩短,但手术时间延长、住院费用增加,以上各项差异均有统计学意义（P＜0.05）;Ⅱ组、Ⅲ组与Ⅰ组相比,术后通气时间、术后住院天数明显缩短,差异具有统计学意义（P＜0.05）,但Ⅱ组、Ⅲ组之间并无差异;三组之间淋巴结清扫数目、术后并发症均差异无统计学意义（P〉0.05）.结论 FTS理念指导下无论开腹手术或腹腔镜手术,均可以加快肠功能的恢复、缩短住院时间,与FTS理念指导下的开腹手术相比,腹腔镜手术还具有出血少、切口小、术后下床活动提前等优势,且不增加手术并发症.

Objective To investigate the effectiveness,safety and advantage of laparoscopic surgery with fast track rehabilitation in colorectal cancer. Methods Clinical data of colorectal cancer patients who underwent operation in our department from June 2004 to October 2010 were retrospectively analyzed. Among these patients, 108 received traditional protocol and open surgery （groupⅠ）, 158 received fast track protocols and open surgery（ group Ⅱ）and 137 were given fast track surgery and laparoscopic surgery（groupm）. Results There was no significant difference in the number of lymph nodes excised and postoperative complications among the three groups. In the group Ⅲ, intraoperative blood loss, the length of operative incision, off- bed time were decreased while the mean operation time and medical treatment cost were increased when compared with those in the groups Ⅰ andⅡ（P 〈0. 05）. The index of post -operative bowel venting and hospital stay were decreased in the group Ⅱ and Ⅲas compared with group Ⅰ,but there was no significant difference between group Ⅱand group m（P 〉0.05 ）. Conclusion Laparoscopic surgery with fast track rehabilitation in the treatment of colorectal cancer can shorten hospital stay and accelerate the recovery of bowel function.