快速康复外科在老年人结直肠手术中的应用

Application of fast-track rehabilitation in elderly patients′ colorectal surgery

目的探讨快速康复外科应用于老年人结直肠手术的安全性与有效性。方法回顾性分析收治的大于65岁的结直肠癌手术患者的临床资料,手术患者均在快速康复外科围手术期处理的指导下进行,包括:术前不长时间禁食,不行机械性肠道准备,术前口服碳水化合物行代谢准备,不放置鼻胃管,采取硬膜外联合全麻的麻醉方式,不常规腹腔引流,术后早期进食,早期下床活动。结果共有72例老年患者在快速康复外科理念指导下行结直肠癌手术,其中76.4%的患者在术后第1天进流质饮食,88.9%的患者在术后第2天进流质饮食,有73.6%的患者在术后第3天进半流质饮食,术后平均通气时间为2.4 d,有9例(12.5%)患者发生全身并发症,10例(13.9%)发生局部并发症,中包括吻合口瘘1例(1.4%)。平均住院天数5.6(1～46)d。30 d内再住院5例(6.9%)。结论快速康复外科应用于老年人结直癌肠手术是安全的、有效的,加快了患者的康复,缩短了住院时间,减少了术后并发症的发生。

Objective To investigate the safety and effectiveness of using fast track surgery in elderly patients′ colorectal surgery.Methods The clinical data of 72 patients older than 65 years with colorectal cancer were retrospectively analyzed.All patients were treated by ＂fast-track＂ rehabilitation program perioperatively that included short fasting time,avoidance of mechanical bowel preparation and without nasogastric tubes,making preoperative carbohydrate loading,use of epidural analgesia combined with general anaesthesia,minimized use of abdominal drains,and early oral feeding and ambulation.Results Of the patients treated with the concept of ＂fast-track＂ rehabilitation,76.4% were able to have liquids orally on the first day after surgery,88.9% able to have liquids orally on the 2nd day after surgery,and 73.6% had semi-liquid orally on the 3rd postoperative day.The mean time of the first bowel movement was 2.4 days.Only 9 patients（12.5%） had general complications,and 10 patients（13.9%） had local complications,including 1 patient（1.4%） with anastomotic leakage.Average postoperative hospital stay was 5.6 days（range 1-46 d）,but 5 patients（6.9%） were readmitted within 30 days.Conclusions Using the ＂fast-track＂ rehabilitation program on elderly patient is not only feasible but also can accelerate postoperative recovery and reduce the duration of hospital stay.