快速流程模式对直肠癌不同手术方案的临床疗效影响

Effect of Fast Track on Clinical Efficacy of Different Operation Projects for Patients with Rectal Cancer

目的探讨快速流程模式(FT)和传统模式(TC)对行不同手术方式的直肠癌患者围手术期的影响。方法回顾性分析2009年1月至2010年1月期间武汉市第八医院肛肠外科收治的285例直肠癌患者的临床资料,患者接受FT或TC处理以及直肠癌高位前切除术(HAR)或低位/超低位前切除术(LAR),从而分为FT+HAR组(n=39)、FT+LAR组(n=17)、TC+HAR组(n=151)及TC+LAR组(n=78),分析比较在FT和TC处理下不同手术方式对患者术中情况和术后康复的影响。结果①手术时间和出血量4组间总体比较差异均无统计学意义(P>0.05)。②术后共发生吻合口漏3例、伤口感染13例和肠梗阻4例,4组间总体比较差异无统计学意义(P>0.05)。③术后首次排便和排气时间的总体差异无统计学意义(P>0.05),而在拔除鼻胃管、引流管和尿管、首次进食、下床活动以及术后住院时间方面的总体差异均有统计学意义(P<0.05)。与TC+HAR组和TC+LAR组比较,FT+HAR组和FT+LAR组患者在拔除鼻胃管、引流管和尿管、首次进食以及下床活动时间均较短,且FT+LAR组患者术后住院时间明显比TC+HAR组和TC+LAR组短,差异均有统计学意义(P<0.05)。结论对于接受不同手术方案的直肠癌患者,FT能加快患者术后康复,但在减少并发症方面并未显示出优势。

Objective To investigate the effect of fast-track（FT） and traditional care（TC） on patients with rectal cancer underwent different surgical strategies in perioperative period.Methods The clinical data of 285 patients with rectal cancer from January 2009 to January 2010 in this hospital were retrospectively analyzed.These patients underwent high anterior resection（HAR） or lower/super lower anterior resection（LAR） under FT and TC were divided into four groups： FT＋HAR（n=39）,FT＋LAR（n=17）,TC＋HAR（n=151）,and TC＋LAR（n=78）,and intraoperative conditions and postoperative rehabilitation were analyzed.Results The baselines characteristics of four groups were basically identical（P0.05）.①The operative time and blood loss of patients in four groups were not statistically significant（P0.05）.②Anastomotic leakage occurred in three cases,wound infection in 13 cases,and intestinal obstruction in four cases after operation,and the difference was not significant in four groups（P0.05）.③The time of first defecation and first flatus of four groups were not statistically significant（P0.05）,but there were significant differences in the time with drainage tube,nasogastric tube,and catheter tube,the time of first intake and first ambulation,and length of stay among four groups（P0.05）.Compared with TC＋HAR and TC＋LAR group,the time with drainage tube,nasogastric tube,and catheter tube,and the time of first intake and first ambulation of patients were shorter in FT＋HAR and FT＋LAR group,and the length of stay of patients in FT＋LAR group was shorter than that in TC＋HAR group and TC＋LAR group（P0.05）.Conclusions FT can promote postoperative rehabilitation of rectal cancer patients underwent different surgical strategies,but which does not demonstrate the superiority of reducing postoperative complications.