加速康复外科指导下的腹腔镜辅助远端胃癌根治术

Fast track surgery in laparoscopy-assisted radical distal gastrectomy

目的探讨在加速康复外科（fasttracksurgery，FTS）理念指导下，联合围手术期应用肠内营养，腹腔镜辅助远端胃癌根治术（1aparoscopyassistedradicaldistalgastrectomy，LADG）的安全性及临床效果。方法将61例远端胃癌患者随机分为3组：FTS＋LADG组（19例）行LADG并应用FFS方案进行围手术期处理，LADG组（22例）行LADG，应用传统围手术期处理、FTS＋开腹远端胃癌根治术（opendistalgastrectomy，ODG）组（21例），即施行ODG并应用FrS方案进行围手术期处理。比较3组患者术后体质量、血清ALB、BUN、CRP、肠蠕动恢复时间、术后住院时间、住院费用、并发症发生等情况。结果FFS＋LADG组手术前后血清ALB水平高于FTS＋ODG组及LADG组，术后第4、7天FTS十LADG组明显高于LADG组（P〈0．05、P〈0．01），术前至第4天血清ALB水平变化Frs＋LADG组、FTS＋ODG组与LADG组间相比差异均具有统计学意义（均P〈0．01、均P〈0．05）；在术后第4、7天FFS＋LADG组血清CRP水平与FTS＋ODG组之间相比差异均具有统计学意义（均P〈0．05）；FTS＋LADG组术后肠蠕动恢复时问明显快于LADG组、FFS＋ODG组（P〈0．05），FTS＋LADG组术后住院时间短于LADG组、FTS＋ODG组，但差异无统计学意义（均P〉0．05），FI＇S＋LADG组住院费用较LADG组明显低（P=0．003），但仍明显高于FTS＋ODG组（P〈0．01）。3组均无吻合口漏等严重并发症，3组总的并发症发生率之间相比差异无统计学意义（P〉0．05）。结论FTS理念应用于腹腔镜辅助远端胃癌根治术可以改善患者的营养状态、减轻应激反应、促进胃肠道功能恢复、加速患者康复、缩短住院时间。

Objective To evaluate the safety and effectiveness of fast track surgery （VFS） in laparoscopy-assisted radical distal gastrectomy （LADG） for gastric cancer. Methods Sixty-one patients with distal gastric cancer were randomly divided into three groups ： FTS ＋ LADG group （ n = 19 ） undergoing LADG and FTS treatments, LADG group （ n = 22） undergoing LADG and traditional perioperative cares, and FTS ＋ ODG （open distal gastrectomy） group （n = 2l ） undergoing ODG and FFS treatments. FTS treatments included avoidance of mechanical bowel cleansing, restrictive perioperative intravenous infusion, early ambulation, early enteral nutrition. The age, sex, body weight, anastomotic mode, number of lymph node dissected, and tumor stage, serum albumin （ ALB）, blood urea nitrogen （ BUN）, C-reaction protein （CRP）, flatus time, postoperative hospital stay, medical cost, and postoperative complications were compared between three groups. Results The level of ALB in FTS ＋ LADG group were higher than in LADG group at the 4th and 7th day after surgery （P 〈 0. 05, P 〈 0. 01 ）. Compared to LADG group, the variation of ALB from preoperation to 4th day after surgery in FTS ＋ LADG group and FTS ＋ ODG group was significant （ P 〈 0. 01, P 〈 0. 05 ）. CRP level between FTS ＋ LADG group and FTS ＋ ODG group were different significantly at 4th and 7th day after surgery （ P 〈0.05, P 〈0.05）. F＇PS ＋ LADG group has earlier recovery of gastrointestinal peristalsis than other two groups （ P 〈 0. 05, P 〈 0. 05 ）. The medical cost inFTS ＋ LADG group was less than in LADG group （ P = 0. 003 ）, but higher than in FTS ＋ ODG group （ P 〈 0.01 ）. Conehtsions The practice of FFS in LADG was safe, effective, improves nutritional status, eases stress reaction, accelerates gastrointestinal peristalsis and postoperative rehabilitation.