加速康复外科理念在腹腔镜直肠癌根治术围手术期的应用价值

The perioperative application value of fast-track surgery in laparoscopic radical operation of rectal cancer

目的:探讨加速康复外科理念在腹腔镜直肠癌根治术围手术期的应用价值。方法:2009年1月至2010年12月为30例腹腔镜直肠癌根治术患者施行加速康复外科(fast track surgery,FTS)处理,以同期30例未行FTS的患者为对照组,观察两组患者手术前后体重与电解质的变化、营养状况、术后排气时间、排便时间、首次下床活动时间、住院时间、患者舒适度及住院费用等指标。结果:60例患者均痊愈出院,无出血、吻合口漏等并发症发生,FTS组术后排气时间、排便时间早于对照组,体重损失小于对照组,术后第5天血清转铁蛋白水平高于对照组,术前电解质紊乱人数少于对照组,患者的舒适度亦显著优于对照组。首次下床活动时间、术后住院时间、住院费用两组差异无统计学意义,结论:腹腔镜直肠癌手术患者围手术期应用FTS理念,可显著改善患者围手术期的舒适度,减少体重损失,减轻电解质紊乱,改善术后营养状况,有效地促进患者康复。

Objective：To investigate the perioperative application value of last-track surgery. （FTS） in laparoscopic radical operation of rectal cancer. Methods：Sixty patients who received laparoseopic rectal cancer radical surgery from Jan. 2009 to Dec. 2010 were randomly divided into observation group and control group, with 30 in each group. The control group received routine care and guidance, while the observation group received FTS treatment. The perioperative changes of body weight and electrolytes, nutritional status, the first exhaust time and defecation time, the time of out-of-bed activity, postoperative hospital stay, degree of comfort and total cost were compared between the two groups. Resets：All patients were cured without complications. The first exhaust time, defecation time in observation group was shorter than those in control group. No significant difference was found in the time of out-of-bed activity, postoperative hospital stay and hospitalization cost between the two groups. The weight loss, serum transferrin at 5 days after operation and electrolyte disturbance were better in observation group than those in control group. The degree of comfort in observation group was higher than that in control group. Conelusions：FTS concept applied in laparoscopic operation of rectal cancer can effectively make patients comfortable, decrease body weight loss, alleviate electrolyte disturbance and improve postoperative nutritional status. It is effective on patients＇recovery.