胃癌围手术期快速康复应用研究

Feasibility of fast-track surgery perioperative radir.al gastrectomy for gastric cancer

目的探讨快速康复外科理念在胃癌病人围手术期应用的可行性及价值。方法将能行一期根治性切除胃癌病人337例，随机分为快速康复外科（FTS）治疗组（n=166）及传统方法治疗（TM）组（n=171）。观察术前一般情况、手术情况、术后恢复情况、术后营养状况及并发症发生率。结果FTS组因不能全程遵守FTS要求而剔除23例。两组病人术前一般情况、手术方式、手术时间、术中出血量、术中尿量差异无统计学意义（P〉0．05），但术中补液量FTS组小于TM组，差异有统计学意义（P〈0．05）。两组均未出现麻醉误吸及围手术期死亡。首次排气时间[（67±31）h与（114±35）h]、首次排便时间[（112±42）h与（138±46）h]、术后住院时间[（10±2）d与（12±3）d]，FTS组均短于TM组，差异均有统计学意义（P〈0．05）；术后营养状况FTS组优于TM组，相关营养指标差异有统计学意义（P〈0．05）。两组问术后相关并发症发生率差异无统计学意义（P〉0．05）。结论胃癌根治术围手术期行快速康复外科处理是安全、可行、有效的，能加速病人术后的恢复，并减轻病人痛苦，降低护士工作量。

Objective To study the feasibility and applied value of fast-track surgery （FTS） perioperative radical gastrectomy. Methods 337 patients with gastric cancer subject to radical gastrectomy were randomly divided into FTS group （n = 166） and traditionai method （TM） group （n = 171）. Preoperative general conditions, intraoperative situation, postoperative recovery, nutritional status, morbidity and complications were observed. Results Twenty-three cases who can not meet FTS re- quirements were eliminated from FTS group. No statistically significant differences were found in preoperative general conditions, operational procedures, operative time, blood loss and urinary volume during operation between these two groups （P〉0. 05）. TM group had more fluid transfusion during operation than FTS group （P〈0. 05）. There were no perioperative deaths in tWO groups. In FTS group one patient had abdominal distension, nausea and vomiting symptoms after discharge, and hospitalized again with conservative management, and discharged 7 days later. In FTS group, anal exhaust time [（67 ± 31） h vs （114± 35） hi, defecation time [（112 ± 42） h vs （138 ± 46） hi, and postoperative hospital stay [（10 ± 2） days vs （12±3）days] were shorter in TM group （all P〈0. 05）. Postoperative nutritional status in FTS group was better than in TM group （P〈0. 05）. There was no significant difference in the postoperative complications between two groups （P〉0. 05）. Conclusion Application of fast-track surgery was feasible, safe and effective before and after radical gastrectomy and it can accelerate patient＇s postoperative recovery, alleviate patient＇s pain and reduce the nurse＇s workload.