“免管免禁”对胸腹腔镜食管癌根治术患者围术期及术后康复的影响

Effect of "non-tube no fasting" on perioperative and postoperative rehabilitation in patients with thoracoscopic-Iapacoscopic esophagectomy for esophageal cancer

目的探讨"免管免禁"理念应用于胸腹腔镜食管癌根治术中对患者围术期及术后康复的影响。方法选取2016年1月至2016年6月间新疆医科大学附属肿瘤医院收治的70例胸腹腔镜食管癌根治术患者,采用随机数字表法分为观察组和对照组,每组35例。观察组患者给予"免管免禁"护理,对照组患者给予传统康复护理,对比两组患者手术时间、术中出血量、淋巴结清扫个数、术后住院时间、术后肛门首次排气与排便时间、血清白蛋白(ALB)及前白蛋白(PA)水平及术后并发症发生率。结果观察组患者术后住院时间为(6.23±2.23)d、术后肛门首次排气时间为(2.12士0.23)d和术后排便时间为(3.25±1.23)d,均短于对照组患者的(11.97±2.36)d、(3.26±0.99)d和(5.42±1.47)d,差异均有统计学意义(均P<0.05)。观察组患者术后1d血清ALB和前白蛋白水平为(37.85±3.02)g/L和(0.21±0.05)g/L,术后3d为(38.57±2.98)g/L和(0.15±0.06)g/L,与手术前(46.23±3.12)g/L和(0.26±0.05)g/L相比均降低,差异均有统计学意义(均P<0.05)。对照组患者术后1d血清ALB和前白蛋白水平为(37.91±3.11)g/L和(0.22±0.07)g/L,术后3d为(38.42±2.75)g/L和(0.16±0.04)g/L,与手术前(45.98±3.08)g/L和(0.23±0.06)g/L相比均降低,差异均有统计学意义(均P<0.05)。但两组患者术后1d、术后3d血清ALB及前白蛋白水平相比,差异均无统计学意义(均P>0.05)。两组患者肺炎、声音嘶哑、心律失常、吻合口瘘和胸腔积液等并发症发生率相比,差异均无统计学意义(均P>0.05)。结论"免管免禁"理念应用于胸腹腔镜食管癌根治术中,缩短患者术后住院时间及胃肠功能恢复时间,改善患者生活质量。

Objective To explore the application of ＂non-tube no fasting＂ concept to perioperative and postoperative rehabilitation in patients with thoracoscopic-lapacoscopic esophagectomy.Methods Select 70 patients treated with thoracoscopic-lapacoscopic esophagectomy at Tumor Hospital Affiliated to Xinjiang Medical University from January 2016 to June 2016.Patients were divided into an observation group and a control group,with 35 patients in each group.Patients in the observation group received nursing care based on ＂non-tube no fasting＂ concept and patients in the control group received conventional nursing and rehabilitation care.Operation time,intraoperative blood loss,number of lymph node cleaning,postoperative hospital stay,first postoperative anal exhaust,defecation time,serum albumin（ALB） level,prealbumin（PA） level and postoperative complications were compared between the two groups.Results Postoperative hospital stay,first anal exhaust and defecation time was shorter in the observation group（6.23 ± 2.23 d,2.12 ±0.23 d and 3.25 ± 1.23 d,respectively） than the control group（11.97 ±2.36 d,3.26 ±0.99 d and 5.42 ± 1.47 d）（P〈0.05）.Serum ALB and PA level was 37.85 ±3.02 g/L and 0.21 ± 0.05 g/L respectively for the observation group after surgery which decreased compared with before surgery（46.23 ±3.12 g/L and 0.26 ± 0.05 g/L）（all P〈0.05）.Serum ALB and PA level was 37.91 ± 3.11 g/L and 0.22 ±0.07 g/L respectively at 1 d after surgery and 38.42 ±2.75 g/L and 0.16 ±0.04 g/L in the control group,which decreased compared with before surgery（45.98 ±3.08 g/L and 0.23 ±0.06 g/L）（all P〈0.05）.There was no significant difference in serum ALB and PA levels between the two groups at postoperative 1 d and 3 d（all P〉0.05）.There was no significant difference in the incidence of complications including pneumonia,voice hoarse,arrhythmia,anastomotic fistula and pleural effusion between the two groups（P〉0.05）.Conclusion application of ＂non-tube no fasting＂ concept to thoracoscopic-lapacoscopic esophagectomy can shorten the postoperative hospital stay and gastrointestinal function recovery time and improve quality of life without increasing the incidence of postoperative complications.