快速流程模式下术后限制补液对吻合口愈合的影响

Clinical effect of restrict rehydration strategy on anastomotic healing of patients with colorectal cancer in fast-track

目的探讨快速流程模式下术后限制补液策略对结直肠癌术后患者吻合口愈合的影响。方法回顾性分析2008年1月至2009年11月期间四川大学华西医院胃肠外科结直肠专业组收治的483例结直肠癌患者的病例资料，其中采用限制补液策略的患者166例（限制补液组），采用常规补液策略的患者317例（常规补液组）。比较采用不同补液方案患者的临床疗效差异。结果从术后早期康复指标来看，快速流程组组患者的首次排气时间（3．9dvs4．4d）、首次下床（2．9dvs3．3d）、首次经口进食（2．9dvs3．6d）、首次拔除尿管（4．6dvs5．5d）和引流管（2．2dvs3．1d）的时间以及术后住院时间（8．7dvs11．6d）均短于传统组患者，差异有统计学意义（P〈0．01）；而2组首次拔除胃管时间（1．1dvs1．2d）比较差异无统计学意义（P〉0．05）。2组间术后并发症发生率比较差异有统计学意义（P〈0．05）。结论术后限制补液策略可以降低结直肠癌患者术后常见并发症的发生率，并对吻合口的愈合有积极意义。

Objective To discuss the clinical effect of restrict rehydration strategy on anastomotie healing of patients with colorectal cancer. Methods 483 cases of colorectal cancer （ from January 2008 to November 2009） were analyzed retrospectively, 166 in fluid restriction group and 317 in tradition therapy group. Postoperative early rehabilitations and complications were studied and compared. Results The first time of passing flatus（3.9 d vs 4.4 d）, first ambulation（2. 9 d vs 3.3 d）, oral intake（2. 9 d vs 3.6 d）, time with use of urinary catheter（4. 6 d vs 5.5 d） , and drains（2. 2 d vs 3.1 d） , and postoperative hospital stay（ 8.7 d vs 11.6 d） in fluid restriction group were significantly earlier or less than those in tradition ther- apy group （ P 〈 0.01 ）, while there were no significant differences in time with use of nasogastric tubes （1.1 d vs 1.2 d） between the 2 groups （ P 〉0. 05）. There was significant difference in the postoperative complications rate between the two groups （ P 〈 0. 05 ）. Conclusions Restrictive fluid regimen could reduce the incidence of common complications for patients after colorectal surgery, and might have a certain promoter action to the anastomotic healing.