快速康复医学在胃癌D2根治术围手术期的应用研究

Analysis of the application of rapid rehabilitation medicine in patients with gastric cancer D2 radical operation

目的研究胃癌D2根治术围手术期中采用快速康复外科(FTS)理念的手术效果。方法选择2013年1月至2015年1月接受胃癌D2根治术治疗的患者146例,依照数字法随机分为观察组和对照组各73例。其中观察组采用FTS进行治疗,对照组采用传统康复治疗。对比两组治疗效果、手术情况、术后并发症。并采用Logistics回归分析影响胃癌D2根治术的治疗效果。结果观察组显效率、总有效率分别为46.58%(34/73)、95.89%(70/73),均分别显著高于对照组的28.77%(21/73)、83.56%(61/73);观察组手术时间、出血量、住院时间以及术后出现吻合口瘘、感染以及腹胀腹泻等并发症的发生率均显著低于对照组,差异均有统计学意义(均P<0.05)。根据治疗效果分为治疗有效组(n=131)和治疗无效组(n=15)。最后通过Logistic回归性分析,将胃癌D2根治术治疗的有效性作为因变量,将其他因素作自变量,得到5个影响因素:肿瘤大小、组织学分型、是否出现淋巴结转移、是否应用FTS以及TNM分期。结论 FTS在胃癌D2根治术围手术期中有显著降低手术时间以及术后恢复时间的作用,同时是否应用FTS是影响胃癌D2根治术治疗效果的主要因素。FTS在临床上具有较高的应用价值,值得推广。

Objective To explore the surgical effect of fast track surgery in the perioperative period of gastric cancer D2 radical operation. Methods From January 2013 to January 2015 for treatment of gastric cancer patients with D2 radical resection of 146 cases, with digital method randomly divided into observation group and control group of 73 cases. The observation group was treated with FTS, the control group was treated with traditional rehabilitation. The treatment effect, operation, postoperative complications, and preoperative of the two groups were compared. Logistics regression analysis was used to analyze the therapeutic effect of D2 radical gastrectomy for gastric cancer. Results T h e explicit efficiency and total effective rate of the observation group was 46. 58% （34/73） , 95. 89% （70/73） , which were significantly higher than those in the control group of 28.77% （21/73） and 83.56% （61/73）. And observation groups operation time, intraoperative blood loss, hospitalization time and postoperative complications such as anastomotic leakage, infection, abdominal distension and diarrhea were significantly lower than those in the control group. The difference was statistically significant （ P 〈 0 . 05）. According to the effect of treatment, the cases were divied into the treatment effectively group （ n = 131） and the treatment Invalidly group （ n = 15）. Finally logistic regression analysis was performed to define 5 influencing factors, including the tumor size, histological type, lymph node metastasis, whether FTS and TNM staging. Conclusion FTS in gastric D2 radical perioperation period has significantly reduced the operative time and recovery time, and whether FTS is a major factor affecting the D2 radical gastrectomy for gastric cancer. It is worth to be popularized in clinical practice.