快速康复外科在食管胃交界腺癌围术期中的应用

Perioperative Application of Fast-track Surgery in Patients with Esophagogastric Junction Adenocarcinoma

目的探讨快速康复外科(FTS)在食管胃交界腺癌患者围术期应用的有效性和安全性。方法选择2010年5月—2012年7月我院收治的食管胃交界腺癌患者80例,采用随机数字表法将患者随机分为对照组和FTS组,每组40例。对照组采用传统的围术期处理方案;FTS组采用快速康复的新型围术期处理方案,主要措施包括术前认真宣教、缩短患者术前禁食水时间、术中维持患者体温、控制补液量、术后早期肠内营养支持、早期下床活动、有效止痛、尽早拔除导尿管及胸管等。比较两组患者手术前后血浆清蛋白水平、胃肠功能恢复时间、住院时间、住院费用及术后并发症等。结果两组不同时间血浆清蛋白水平比较,差异有统计学意义(F组间=85.961,P=0.000;F时间=45.076,P=0.000);其中术前两组患者血浆清蛋白水平比较,差异无统计学意义(q=1.893,P>0.05);术后1、3、7 d,FTS组血浆清蛋白水平高于对照组,差异均有统计学意义(q值分别为5.629、5.775和3.815,P<0.05)。FTS组患者肠鸣音恢复时间、肛门排气时间、住院时间和住院费用均低于对照组,差异有统计学意义(P<0.05)。两组并发症发生率〔7.5%(3/40)与15.0%(6/40)〕比较,差异无统计学意义(χ2=1.1268,P=0.2885)。结论 FTS在食管胃交界腺癌患者围术期中的应用是有效、安全的,能明显减轻患者痛苦,加速患者术后康复,节省医疗费用,具有广阔的应用前景。

Objective To investigate the feasibility and safety of fast - track surgery （FYS） in perioperative period of the patients with esophagogastric junction adenocarcinoma. Methods 80 patients with esophagogastric junction adenocarcinoma admitted to our hospital from May 2010 to July 2012 were randomly divided into control group and FFS group, with each group 40 cases. The control group was given conventional perioperative treatment, while the FTS group was given FFS perioperative treat- ment, such as detailed preoperative education, shorter preoperative fasting time, incubation in operation, fluid infusion control, early postoperative ambulation and enteral nutrition, potent analgesia, early removal of urethral catheter and chest drainage tube, etc. The plasma albumin, recovery time of gastrointestinal function, hospital stay, hospital expenses and complications were compared between the two groups. Results The plasma albumin at different time between the two groups showed statistically sig- nificant difference （Fgroup =85. 961, P =0. 000; Ftime =45. 076, P =0. 000） . The plasma albumin between the two groups be- fore treatment showed no statistically significant difference （ q = 1. 893, P 〉 0. 05 ） . One day, three days and seven days after treatment, the plasma albumin level in FTS group was significantly higher than the control group （q = 5. 629, 5. 775 and 3. 815, P 〈 0. 05 ） . The bowel sounds recovery time, anus exhaust time, length of hospital stay and hospital expensees were significantly lower than the control group （P 〈0. 05） . The complication incidence between the two groups [7.5% （3/40） vs. 15.0% （6/ 40） ~ showed no statistically significant difference （χ2 = 1. 1268, P = 0. 2885 ） . Conclusion It is safe and efficient to apply FIS in perioperative period of the patients with esophagogastric junction adenocarcinoma. FFS can significantly reduce pain and medical cost and accelerate recovery after surgery.