快速康复外科对胃癌手术患者临床指标及术后并发症的影响

Effect of fast track surgery on clinical parameters and postoperative complications in patients with gastric cancer

目的:探讨快速康复外科(fast track surgery,FTS)对胃癌手术患者的临床指标及术后并发症的影响.方法:回顾性分析2008/02-2011/05广州军区广州总医院普外科收治的168例胃癌手术患者资料,其中2009/12-2011/05连续收治的82例采用快速康复外科治疗(FTS组),2008/02-2009/11连续收治的86例按传统围术期处理(传统组),两组行非随机对照研究.比较两组术后首次排气、排便时间、住院时间、住院费用及术后并发症情况.结果:FTS组同传统组相比,术后首次排气时间(2.6dvs4.6d)、排便时间(3.3dvs5.2d)显著提前,住院时间(4.6dvs8.1d)明显缩短,住院费用显著降低(2.3万元vs2.9万元),且差异均有显著统计学意义(P<0.05).FTS组肺部并发症(5/82,6.1%)显著低于传统组(14/86,16.3%),差异显著(P<0.01);FTS组术后消化系瘘发生率(4/82,4.9%)稍高于传统组(3/86,3.5%),但差异无统计学意义(P>0.05).FTS组4例消化系瘘中2例再手术,其中1例死亡,而传统组中3例均通过非手术治疗治愈.其余单个并发症两组无明显差异.FTS组总体并发症(22/82,26.8%)略低于传统组(28/86,32.6%),但无统计学差异(P>0.05).两组各有1例死亡.FTS组再入院率(4/82,4.9%)稍高于传统组(3/86,3.5%),但无统计学意义(P>0.05).结论:FTS应用于胃癌手术安全有效,可促进术后胃肠功能恢复,缩短住院时间,降低住院费用.FTS并不增加术后并发症率,但可能增加消化系瘘、出血等严重并发症的诊断和治疗难度.

AIM：To evaluate the effect of fast track surgery（FTS） on clinical parameters and postoperative complications in patients with gastric cancer.METHODS：A non-randomized controlled study was undertaken.Data were collected from 168 patients with gastric cancer who were treated at General Hospital of Guangzhou Military Command from February 2008 to May 2011,including 82 patients having undergone FTS and 86patients having undergone conventional perioperative care.Outcomes were assessed using the time to first flatus and defecation,the length of postoperative hospital stay,medical cost and postoperative complications.RESULTS：The time to first flatus（2.6 d vs 4.6 d） and defecation（3.3 d vs 5.2 d） and the length of hospital stay（4.6 d vs 8.1d） in the FTS group were significantly shorter,and the medical cost（23 vs 29 thousand yuan） was significantly less than those in the conventional treatment group（all P 0.05）.The incidence of pulmonary complications（6.1% vs 16.3%,P 0.01） was much lower in the FTS group than in the conventional treatment group.The incidence of digestive tract fistula was higher in the FTS group than in the conventional treatment group（4.9% vs 3.5%）,but the difference had no statistical significance（P 0.05）.In four patients developing fistula in the FTS group,two patients received operation again,whereas all the three patients developing fistula in the conventional treatment group received non-operation treatment.The overall incidence of complications in the FTS group was lower than that in the conventional treatment group（26.8% vs 32.6%）,but the difference had no statistical significance（P 0.05）.One patient died in each group.The rate of readmission in the FTS group was higher（4.9% vs 3.5%）,but the difference had no statistical significance（P 0.05）.CONCLUSION：Fast track surgery is effective and safe in patients with gastric cancer,and it might contribute to gut function recovery,shorten hospital stay time and reduce medical cost.FTS does not increase the incidence of postoperative complications,but might increase the diff iculty of diagnosis and treatment of some severe complications such as digestive tract fistula and hemorrhage.