快速康复外科理念在腹腔镜结肠切除术中的应用

Applications of fast track surgery in patients with laproscopic colorectal resection

目的探讨快速康复外科(FTS)理念的应用对结肠癌患者术后恢复的影响。方法选取结肠癌患者62例为研究对象,按照随机数字表法分为观察组和对照组各31例,对照组应用传统围术期处理行腹腔镜结肠癌切除术,观察组在FTS理念指导下行腹腔镜结肠癌切除术,2组分别于术前、术后第3天、术后第7天测定C反应蛋白(CRP)、白细胞介素6(IL-6)、白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)、血红蛋白(Hb)等;同时比较住院期间并发症发生情况。结果 1术后第3天,观察组患者血清CRP和IL-6的含量低于对照组(P<0.05),术后第7天,各组患者的CRP和IL-6水平仍未达到术前水平,但观察组CRP显著低于对照组,差异有统计学意义(P<0.05);2术后第3天,ALB、PRE、TRF、RbP、Hb相关蛋白含量均低于手术前(P<0.05),但观察组含量高于对照组(P<0.05);术后第7天,观察组ALB、PRE、TRF、RBP、Hb含量高于对照组(P<0.05);3观察组肺部感染、切口感染的发生率均明显低于对照组(6%与13%,3%与10%),差异有统计学意义(P<0.05)。结论通过FTS理念的应用,可有效改善腹腔镜结直肠癌手术后的炎症反应,加速营养指标及胃肠功能的恢复,值得临床广泛推广和应用。

Objective To investigate the effects of fast track surgery （FTS） on patients＇recovery after colon cancer operation .Methods Sixty‐two cases of patients with colon cancer were selected and randomly divided into two groups .Thirty‐one cases of observation group were treated with fast track protocols and laparoscopic surgery while 31 cases of control group were treated with traditional protocol and laparoscopic surgery .CRP ,IL‐6 ,ALB , PRE ,TRF ,RBP and Hb were tested before operation and 3 and 7 days after surgery ,respectively .And the rate of complications during hospitalization was assessed .Results ①On the day 3 postoperatively ,the levels of CRP and IL‐6 in observation group were significantly higher than those in control group （P〈0.05） .On the day 7 post‐operatively ,CRP and IL‐6 were still not recovered to preoperative level ,but observation group＇s were significantly lower than those in control group （P〈0.05） .②On the day 3 postoperatively ,ALB ,PRE ,TRF ,RBP and Hb obviously reduced compared with the other two groups before operation （P〈0.05） ,and the parameters in control group were more lower than those in the observation group （P〈 0.05） .On the day 7 postoperatively ,ALB , PRE ,TRF ,RBP and Hb were obviously higher in the observation group than those in control group （P〈0.05） .③The incidence rate of pulmonary infection and wound infectionwas significantly lower than that in the control group （6% vs 13% ,3% vs 10% ） ,and theses differences were statistically significant between the two group （P〈0.05） .Conclusion Laparoscopic colorectal resections with FTS could effectively mitigate the inflammatory re‐sponse and nutritional impairment ,and accelerate postoperative rehabilitation .It is worthy of wider promotion and application .