用加速康复外科理念治疗胃癌患者的临床应用探讨

Discussion with Clinical Application for Fast Track Rehabilitation Concept in Treatment of Patients with Gastric Cancer

目的探讨加速康复外科理念在胃癌患者围手术期治疗过程中的应用。方法将80例胃癌患者随机分为传统方法组(n=40)和加速康复组(n=40),比较2组患者术前1 d、术后第1、3天的外周血总淋巴细胞计数(TLC)、C反应蛋白(CRP)、IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平,记录2组患者术后发热持续时间、首次排气时间,住院时间以及术后并发症情况。结果加速康复组术后首次排气时间提前,术后发热持续时间及住院时间均较传统方法组短(P<0.05),2组患者术后并发症发生率差异无统计学意义(P>0.05);2组患者术后第1天TLC与术前1 d相比降低,而CRP与术前1 d相比增高,差异均有统计学意义(P<0.01)。术后第3天加速康复组CRP较传统方法组明显降低(P<0.05),IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平均比传统方法组升高(P<0.05)。结论胃癌患者行加速康复外科理念治疗是安全有效的,且能减轻手术创伤对患者免疫功能的打击,促进患者康复。

Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC）, Creaction protein （CRP）, IgG, IgM, IgA, CD3＋, CD4＋, CD8＋, and CD4＋/CD8＋ in serum on the days Of 1 d before operation and 1 and 3 d after operation, and to record the duration of fever, first ventilation time of flatus, postoperative hospital stay time, and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group, and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P 〈 0. 05）. The incidence difference of complica tions in two groups had not statistic significance （P〉0. 05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P 〈 0. 01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM, IgA, CD3＋, CD4＋, CD8 ＋, and CD4＋/CD8 ＋ were higher than that in conventional group （P〈 0. 05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient, which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation.