快速康复外科理念联合腹腔镜治疗结直肠癌患者价值探讨

Value of fast track surgery and laparoscopy in treatment for colorectal cancer

目的探讨快速康复外科(FTS)理念联合腹腔镜治疗结直肠癌手术的有效性和安全性。方法将择期行结直肠癌手术120例随机分成4组:传统的开腹手术对照组(Ⅰ组,28例),FTS理念开腹手术组(Ⅱ组,30例),单纯腹腔镜手术组(Ⅲ组,32例),FTS理念联合腹腔镜手术组(Ⅳ组,30例)。分析研究4组患者手术时间、静脉输液时间、手术切口长度、术中出血量、首次通气时间、术后住院天数和住院费用等指标。结果Ⅳ组和Ⅲ组与Ⅰ组和Ⅱ组相比较手术时间明显延长,术中出血量明显减少,手术切口明显减小,各项差异均有统计学意义(P<0.05)。Ⅳ组和Ⅱ组与Ⅰ组比较术后肠功能恢复时间和住院时间都明显缩短,各项差异均有统计学意义(P<0.05)。Ⅳ组与Ⅱ组相比较术后肠功能恢复时间、静脉输液时间和住院天数差异均无统计学意义(P>0.05)。Ⅳ组与Ⅲ组相比较术后静脉输液时间,半流质饮食时间提前,住院天数明显缩短,差异均有统计学意义(P<0.05)。结论 FTS理念联合腹腔镜治疗结直肠癌,术后肠功能恢复快,住院时间短;与FTS理念开腹手术相比,具有术中出血量少、切口小的优点,但手术时间长。

Objective To investigate the effectiveness,safety and advantage of fast track rehabilitation protocols in laparoscopic surgery for colorectal cancer.Methods 120 patients were randomized to receive traditional protocols and open surgery（groupⅠ,n=28）,fast track protocols and open surgery（groupⅡ,n= 30）,laparoscopic surgery alone（group Ⅲ,n=32）,fast track surgery and laparoscopic surgery（groupⅣ,n=30）.Analysis of four group patients operative time,intravenous infusion time,incision length,blood loss,number of lymph node dissection,gut function,postoperative hospital stay and hospital costs and other indicators.Results Blood loss was less and incision length was shorter,and operative time was longer in group Ⅲ and Ⅳ than those in group I and Ⅱ（P0.05）.Recovery of bowel function in groupsⅣandⅡ was faster,and postoperative hospital stay was shorter in group Ⅳ and Ⅱthan that in groupI（P0.05）,but there was no significant difference between group Ⅳ and groupⅡ（P0.05）.intravenous infusion time,semi-liquid diet time and postoperative hospital stay were shorter in group Ⅳ than in groupⅢ（P0.05）.Conclusion Postoperative hospital stay can be shortened and recovery of bowel function can be accelerated in laparoscopic surgery with fast track rehabilitation compared to traditional care group.Compared to open surgery fast track rehabilitation,blood loss was less and incision was smaller,in laparoscopic surgery with fast track surgery protocols.