快速康复外科对食管癌手术患者胰岛素抵抗指标的影响

Effect of fast track surgery on insulin resistance indexes of esophageal cancer patients

目的探讨快速康复外科（FTS）方案对食管癌手术患者胰岛素抵抗指标的影响。方法选取2009年11月至2011年3月在我院胸外科行根治外科治疗的食管癌患者，采用信封法随机分为FTS组（n=34）和对照组（n=34）。记录两组患者术后肛门首次排气、排便时间，术后住院时间，住院总费用及手术并发症。于术前，术后第1、3、7天监测两组患者的胰岛素抵抗相关指标，包括空腹血糖（FBG）、空腹胰岛素（FINS）、白细胞介素-6（IL-6）和C反应蛋白（CRP），计算胰岛素抵抗指数（HOMA-IR）。结果FTS组患者术后肛门首次排气时间[（1．91±1．13）d比（2．95±1．25）d，P=0．000]、排便时间[（3．75±1．54）d比（4．84±1．76）d，P=0．007]显著短于对照组，住院总费用显著低于对照组[（3．19±0．42）万元比（3．98±0．36）万元，P=0．000]。术前两组患者胰岛素抵抗的相关指标差异均无统计学意义（P均＞0．05）。术后第1天，FTS组患者log-HOMA-IR值[（0．97±0．52）比（1．54±O．57），P=0．000]、FINS[（11．87±4．55）μU／ml比（17．16±6．90）μU／ml，P=0．000]、IL-6[（124．15±21．39）ng／L比（138．78±23．60）ng／L，P=0．009]和CRP[（62．92±14．78）mg／L比（71．07±14．51）mg／L，P=0．025]水平显著低于于对照组；术后第3天，FTS组患者log-HOMA-IR值[（0．86±0．47）比（1．27±0．58），P=0．002]、FINS[（9．56±4．37）μU／ml比（14．91±6．54）μU／ml，P=0．000]、IL-6[（140．94±25．12）ng／L比（153．89±24．06）ng／L，P=0．035]和CRP[（138．59±21．61）mg／L比（153．17±25．20）mg／L，P=0．019]水平显著低于于对照组；术后第7天，vrs组患者CRP水平显著低于对照组[（53．074-15．84）mg／L比（61．59±16．28）mg／L，P=0．032]。结论FTS方案用于食管癌患者可促进早期胃肠道功能恢复，减轻应激反应，降低术后胰岛素抵抗，有效加速术后患者的康复，具有一定的可行性。

Objective To investigate the influence of fast track surgery （FFS） on insulin resistance indexes in esophageal cancer patients. Methods A total of 68 esophageal cancer patients receiving radical operation in our hospital from November 2009 to March 20ll were randomly divided into 2 groups by envelope method： FTS group （ n = 34 ） and control group （ n = 34）. The postoperative first passage of gas by annus and defecation, postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorde＆ Insulin resistance indexes were measured before operation as well as on the 1 st, 3rd, and 7th postoperative days, including fasting blood-glucose （FBG）, fasting insulin （FINS）, serum level of interleukin-6 （IL-6）, and C-reactive protein （CRP）. The insulin resistance index （HOMA-IR） was calculated at the same time points. Results The postoperative time of first passage of gas [ （ 1.91 ± 1.13） d vs. （2. 95 ± 1.25） d, P = 0. 000 ] and defecation [ （3.75 ± 1.54） d vs. （4. 84 ± 1.76） d, P = 0. 007 ] in FTS group were significantly shorter compared with control group, and the total hospitalization expenditure was significantly lower in FTS group [ （3.19 ± 0.42） ten-thousand yuan vs. （3.98 ± 0.36） ten-thousand yuan, P = 0. 0001. The preoperative insulin resistance indexes showed no significant differences between the two groups （ all P 〉 0. 05 ）. One day after operation, the levels of log-HOMA-IR （0. 97 ± 0. 52 vs. 1.54±0.57, P=0.000）, FINS [ （11.87±4.55） μU/mlvs. （17.16±6.90） μU/ml, P=0.000], IL-6 [ （124.15±21.39） ng/L vs. （138.78±23.60） ng/L, P=0.009], and CRP [ （62.92±14.78） mg/L vs. （71.07 ± 14. 51 ） mg,/L, P =0.0251 in FTS group were significantly lower than those in control group. Three days after operation, the levels of log-HOMA-IR （0. 86 ± 0.47 vs. 1.27 ± 0.58, P = 0. 002 ）, FINS [ （9. 56±4. 37 ） μU/ml vs. （ 14. 91 ± 6. 54） μU/ml, P = 0. 000 ], IL-6 [ （ 140.94 ± 25.12） ng/L vs. （ 153. 89 ± 24.06） ng/L, P=0.035], andCRP [ （138.59±21.61） mg/Lvs. （153.17±25.20） mg/L,P=0.019] in FTS group were significantly lower than those in control group. Seven days after operation, the level of CRP in FTS group was significantly lower than that in control group [ （53.07 ± 15.84） mg/L vs. （61.59 ± 16. 28） mg/L, P =0. 032]. Conclusion FTS may promote the early recovery of gastrointestinal function, reduce stress reaction and postoperative insulin, thus being conducive to fast rehabilitation of esophageal cancer patients.