加速康复外科对直肠癌根治术后患者应激指标的影响

Effects of enhanced recovery after surgery technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery

目的探讨加速康复外科(ERAS)对腹腔镜直肠癌根治术后患者应激指标的影响。方法选取笔者所在医院接受腹腔镜直肠癌根治术(Dixon)患者120例,按随机数字表法随机分为ERAS组(n=60)和传统处理组(n=60)。ERAS组患者围手术期采用ERAS理念进行相应处理,传统处理组围手术期采用传统方法处理。比较2组患者入院时、术前1 h以及术后24 h、48 h和72 h时的应激指标如白细胞计数(WBC)、C-反应蛋白(CRP)及白细胞介素6(IL-6)的水平,并记录2组患者的术后首次肛门排气时间、术后首次排便时间、总住院时间及再入院率。结果 (1)2组患者性别、年龄、肿瘤大小及肿瘤分期比较差异均无统计学意义(P>0.05)。(2)2组患者入院时及术前1 h时的WBC、CRP及IL-6水平比较差异均无统计学意义(P>0.05);术后24 h、48 h及72 h时,ERAS组的WBC、CRP及IL-6水平均明显低于传统处理组(P<0.05)。(3)ERAS组的术后首次肛门排气时间、术后首次排便时间及总住院时间均明显短于传统处理组(P<0.05),2组患者的再入院率比较差异无统计学意义(P>0.05)。结论 ERAS方案有助于减轻腹腔镜直肠癌根治术后患者的应激反应,促进患者术后早日恢复。

Objective To observe effects of enhanced recovery after surgery （ERAS） technique on stress indicators in patients undergoing laparoscopic rectal cancer surgery. Methods One hundred and twenty patients underwent laparoscopic rectal cancer surgery （Dixon） in the Xinqiao Hospital of the Third Military Medical University were included in this study and then were randomly divided into an ERAS group （n=60） and a conventional treatment group （n=60）. The patients in the ERAS group were treated with an ERAS concept during the perioperative period. The patients in the conventional treatment group were treated with a traditional treatment concept during the perioperative period. The stress indicators including white blood cell count （WBC） and C-reactive protein （CRP） and interleukin （IL）-6 levels were compared in the two groups at admission, 1 h before operation, and 24 h, 48 h, and 72 h after operation. The first postoperative anal exhaust time, the first postoperative defecation time, the total hospitalization time, and readmission rate were also recorded after operation. Results ① The age, gender, tumor diameter, and TNM stage had no significant differences in these two groups （P〉0.05）. ② There were no significant differences in the WBC, CRP and IL-6 levels at admission and 1 h before operation between the two groups （P〉0.05）. The levels of CRP, IL-6, and WBC in the ERAS group were significantly lower than those in the conventional treatment group at 24 h, 48 h and 72 h after operation （P〈0.05）. ③ The first postoperative anal exhaust time, the first postoperative defecation time, and the total hospitalization time in the ERAS group were significantly shorter than those in the conventional treatment group （P〈0.05）. There was no significant difference in readmission rate between the two groups （P〈0.05）. Conclusion ERAS concept is helpful in reducing stress response and could promote earlier recovery of patients with rectal cancer.