加速康复外科理念指导下行结直肠癌根治术的疗效评价

Evaluation of curative effect of enhanced recovery after surgery in colorectal cancer

目的评价加速康复外科(ERAS)理念指导下行结直肠癌根治术的疗效。方法回顾性分析新疆医科大学第一附属医院2013年1月-2015年12月收治的102例结直肠癌患者的临床资料。将符合纳入标准的病例分为3组:A组行经腹手术结合传统的围手术期处理,B组采取腹腔镜手术结合传统的围手术期处理,C组腹腔镜手术结合ERAS理念。比较3组病人手术时间、出血量、肠功能恢复时间、术后住院时间、术后并发症等。结果3组手术时间差异无统计学意义(P=0.415)。B组和C组术中出血量差异无统计学意义(P=0.969),B、C组与A组差异均有统计学意义(P<0.001)。C组术后肠功能恢复时间明显优于B组(P<0.001)。C组肠功能恢复时间明显早于B组(P<0.001)。3组术后吻合口瘘(P=0.8821)及切口感染(P=0.463)发生率差异无统计学意义。A组肺部感染发生率明显高于C组(P=0.026)。结论 ERAS理念与腹腔镜技术的结合,可减少围手术期的应激反应,加快肠道功能恢复,改善营养状况,更好地促进患者术后快速康复。

Objective To evaluate the curative effect of radical resection of colorectal cancer （CRC） performed under the guidance of enhanced recovery after surgery. Methods Retrospectively analyzed were 102 patients with CRC hospitalized in the first affiliated hospital of Xinjiang medical university between January 2013 and December 2015.Those cases meeting the inclusion and exclusion criteria set up by us were divided into three groups, group A of abdominal surgery combined with the traditional perioperative period; Group B of laparoscopic surgery combined with traditional perioperative management, group C of laparoscopic surgery combined with ERAS. Compared were the three groups in terms of operation time, blood loss, bowel function recovery time, postoperative hospital stay time, postoperative complications, etc. Results There was no statistically significant difference of operation time between the three groups （P =0.415）.The blood loss was analyzed to be significantly higher than that in group A （P ~0.001）. how- ever, no significant difference was observed between group B and group C （P =0.969）in terms of postop- erative complications, anastomotic fistula （P = 0.8821） and incision infection （P = 0.463）.Incidence of pulmonary infection in group A was shown to be significantly higher than that in group C （P =0.026）. Conclusion ERAS combined with the laparoscopic was shown to be capable of reducing perioperative stress response, accelerating the intestinal function recovery, improving nutrition and promoting the rapid recovery of patients after operation.