结直肠癌患者围手术期快速康复外科新理念治疗的效果观察

Clinical effects of perioperative fast-track surgery program in patients with colorectal cancer

目的:观察结、直肠癌患者围手术期应用快速康复外科(FTS)新理念治疗的临床效果。方法:选取91例结、直肠癌手术患者,随机分为快速康复组(FTS组)48例和常规治疗对照组(对照组)43例。FTS组采用FTS新理念进行围手术期处理,包括术前心理辅导、口服肠内营养粉及导泻药物导泻,术中控制输液量、采用小手术切口,术后用非甾体类止痛药镇痛、早期拔尿管和胃管、鼓励尽早下床活动等。对照组采用传统方法的围手术期处理,包括术前口服抗生素、禁食水、清洁灌肠,术中采用以充分暴露为原则的常规切口、大量补液、常规引流、阿片类止痛药物镇痛、术后3 d拔尿管等。比较两组术后的首次排气时间、首次排便时间、恶心呕吐的发生率、手术并发症的发生率、术后营养状况、住院时间、住院总费用等指标。结果:与对照组比较,FTS组术后首次排气、排便时间缩短,手术并发症的发生率降低,术后营养状况良好,住院时间缩短,住院总费用降低。两组术后恶心、呕吐发生率差异无统计学意义。结论:应用FTS新理念可明显提高结、直肠癌患者围手术期的体质,减轻手术对机体的损伤,减少手术并发症的发生率,并缩短住院时间节省住院总费用。

Objective： To observe the clinical effects of perioperative fast-track surgery （FTS） program in the patients with colorectal cancer. Methods.. Ninety-one patients with colorectal cancer were randomly divided into FTS group （48 cases） and control group （43 cases）. The patients in the FTS group received FTS program perioperatively, including psychological aid, enteral nutrition and catharsis before operation, control of the volume of transfusion during the operation, small incision for operation, non-steroid analgesic treatment, early withdrawal of urethral catheter and gastric tube, and encouraging patients to be ambulatory early after operation. The patients in the control group received routine protocol perioperatively, including taking antibiotics orally, fasting, cleansing enema before operation, routine incision, large-volume transfusion, routine dainage, opioid analgesic for pain, with- drawn of urinary catheter 3 days after operation. The duration from operation to the first flatus and defecation, the incidence of nausea and vomiting, rate of postoperative complications, postoperative nutritional state （serum albumin level）, and postoperative hospital stay, and hospitalization expenditure were compared between the two groups. Results：Compared to the control group, in the FTS group the duration from operation to the first passage of flatus and defecation was shortened, the incidence of complications after operation was reduced, the serum albumin level was higher, the hospitalization time was shortened, and the hospitalization expenditure reduced. The rate of postoperative nausea and vomiting was similer between the two groups. Conclusions： FTS program can obviously increase the perioperative body constitution of the patients with coloreetal cancer, reduce the degree of operative trauma, decrease the incidence of complications, shorten hospital stay and lower hospitalization expenditure.