基于营养风险筛查的快速康复外科在食管癌围术期的应用

Application of fast-track surgery in the management of nutritional risk on patients with esophageal carcinoma after esophagectomy perioperatively

目的 探讨基于营养风险筛查（NRS）的快速康复外科（FTS）模式在食管癌患者围术期治疗中的临床应用.方法 选取2008年1月至2013年12月本院同期住院食管鳞癌适合手术治疗的患者170例,随机分为两组（n=85）：研究组术前采用营养风险筛查2002 （NRS2002）方法进行评估并予以干预性治疗（FTS组）;对照组按传统围术期方法治疗（CPM组）.观察两组患者术后首次排气、首次排便时间、拔除胸腔引流管时间、住院时间以及手术并发症等情况.结果 两组手术时间差异无统计学意义（P＞0.05）.与CPM组比较,FTS组术后首次排气时间[（59.01±2.73）h比（90.16±2.82）h]、首次排便时间[（3.35±1.37）d比（4.78±1.74）d]、拔除胸腔引流管时间[（2.76±0.34）d比（4.39±0.25）d]、术后住院时间[（8.16±0.80）d比（10.93±1.39）d]以及总并发症发生率[7.06％ （6/85）比20.00％ （17/85）]均显著减少,差异有统计学意义（x2=7.42,均P＜0.05）.结论 应用基于营养风险筛查的FTS治疗模式,可有效促进食管癌患者术后的康复,减少术后并发症发生率,缩短住院时间,从而改善患者的临床结局.

Objective To evaluate the influence of fast-track surgery in perioperative period on the clinical outcomes of patients at nutritional risk in respectable esophageal cancer surgery perioperatively.Methods A total of 170 esophageal carcinoma patients receiving radical operation in our hospital from January 2008 to December 2013 were randomly divided into two groups by simple random method （n =85 each）：one group was treated with the new concept of FTS-based on nutritional risk screening （FTS group）,and the other control group received conventional perioperative management （CPM group）.The postoperative first passage of flatus and defecation,time to drainage tube removal,postoperative hospital stay,and morbidity of the postoperative complication were recorded and compared.Results The time to drainage tube removal and length of postoperative hospital stay were significantly lower in the FTS group than those in the CPM group,and the overall postoperative complication rate was 7.06% （6/85） in the FTS group and 20.00% （17/85） in the CPM group （all P 〈0.05）.In FTS group,the first flatus time was （59.01 ±2.73） h,the first defecation time was （3.35 ± 1.37） d,removing time of chest tube was （2.76 ±0.34） d,and postoperative hospital days was （8.16 ± 0.80） d; in the control group,they were （90.16 ±2.82） h,（4.78 ± 1.74） d,（4.39 ±0.25） d,and （10.93 ± 1.39） d respectively,showing significant differences （all P 〈0.05）.The operative time was similar between these two groups.Conclusion The new concept of FTS by nutrition risk screening and intervention apparently can accelerate recovery after esophagngastrectomy,reduce the rate of overall complications,promote bowel function recovery,and decrease morbidity in the perioperative period for patients with esophageal carcinoma.