加速康复外科及腹腔镜在胃癌中的应用研究

Fast-track surgery and laparoscopy in gastrectomy for gastric cancer

目的:评价加速康复外科(fast track surgery,FTS)新理念及腹腔镜技术常规应用于胃癌根治术的可行性。方法:回顾分析2005年3月至2010年3月由同一医师完成的胃癌根治术的临床资料,按围手术期理念和手术技术分为3组,A组(66例)采用传统围手术期处理方法行开腹手术,B组(105例)应用FTS理念行开腹手术,C组(100例)应用FTS理念行腹腔镜手术。对比3组患者的临床指标及实验室指标。结果:3组手术时间差异均有统计学意义(P<0.05),C组时间最长,术中出血量最少(P<0.05)。淋巴结清扫数量及并发症发生率差异无统计学意义(P>0.05)。B、C组与A组相比,患者术后肠功能恢复时间短(P<0.05),术后住院时间短(P<0.01),术后应激反应指标上升幅度低(P<0.05)。C组与B组相比,患者术后肠道功能恢复时间和住院时间略短,术后应激反应指标上升幅度略低,但除C反应蛋白外差异均无统计学意义(P>0.05)。结论:FTS围手术期处理方法是加快胃癌患者术后康复的关键因素,不论开腹或腹腔镜手术均应在加速康复外科的理念下开展。FTS联合腹腔镜手术治疗胃癌较传统方法优势显著。

Objective：To evaluate the feasibility of fast-track surgery （FTS） and laparoscopy as a routine perioperative man- agement in gastrectomy for gastric cancer. Methods ： The clinical data of patients who underwent gastrectomy performed by the same sur- geon from Mar. 2005 to Mar. 2010 were retrospectively analyzed. The patients were divided into three groups according to the periopera- tire measures and surgical technique,group A （66 cases） was open gastrectomy with traditional perioperative treatment,group B （105 cases） was open gastrectomy with FTS, and group C （100 cases） was laparoscopic gastrectomy with FTS. Clinical data and lab index were compared in the three groups. Results ： The operation time was significantly different among the three groups （P 〈 0.05）, and the group C was the longest with least blood loss （P 〈 0.05）. No significant difference existed in the number of resected lymph node and postoperative complications among the three groups （P 〉 0.05）. In group B and C, the recovery of bowel function was faster （P 〈 0.05） ,the postoperative hospital stay was shorter（P 〈 0.01 ）, and the surgical stress response was minor （P 〈 0.05 ）, compared with group A. Recovery of bowel function in group C was a little faster, postoperative hospital stay was a little shorter, and surgical stress re- sponse was a little minor than group B, but with no significant difference （ P 〉 0.05 ） except the C-reactive protein （ P 〈 0.05 ）. Conclu- sions ： FTS is essential for improvement of postoperative recovery of patients with stomach cancer, and should be followed in the open and laparoscopic gastrectomy. FTS combined with laparoscopy is superior to traditional stomach cancer treatment.