腹腔镜胃癌根治术中应用加速康复外科对术后近期营养指标的影响

Effect of enhanced recovery after surgery on the postoperative short-term nutrition indicators after laparoscopic gastrectomy for gastric cancer

目的观察加速康复外科(enhanced recovery after surgery,ERAS)对腹腔镜胃癌根治术病人术后近期营养指标的影响。方法将以2016年1~7月期间收治的胃癌病人为研究对象,按腹腔镜胃癌手术操作指南进行腹腔镜辅助下D2根治术的65例胃癌病人随机分为2组,常规组(n=32)应用传统围手术期处理行腹腔镜手术,观察组(n=33)在ERAS理念指导下行腹腔镜手术。2组病人分别于术前、术后第1天、术后第3天、术后第7天抽取外周血测定白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、视黄醇结合蛋白(RbP)、血红蛋白(Hb),监测术后第1天、术后第7天和术后第30天的体重与术前体重的比值(WR),并进行对比分析。结果术前各项指标2组间差异均无统计学意义。术后第1天,各组指标均较术前降低,2组之间差异无统计学意义(P>0.05);术后2组病人ALB、PRE、TRF水平逐渐上升,与常规组相比,术后第7天时观察组ALB水平为(38.6±2.0)g/L、PRE水平为(192.2±16.1)mg/L,升高更明显,差异有统计学意义(P<0.05)。常规组术后第1天、术后第3天RbP水平均低于术前(P<0.05),而观察组术后RbP水平与术前无明显差异。2组病人术后Hb水平均低于术前(P<0.05),术后第7天2组均恢复至术前水平,2组之间Hb水平分别为(109.4±7.11)g/L和(108.7±8.11)g/L,差异无统计学意义。2组病人术后WR逐渐下降,术后第7天时常规组为0.93±0.053,低于观察组的0.96±0.028,差异有统计学意义(P<0.05)。结论腹腔镜胃癌根治术中应用ERAS理念,可维持病人术后营养状态。

Objective To investigate the influence of enhanced recovery after surgery（ERAS）on the postoperative short-term nutrition indicators after laparoscopic gastrectomy for gastric cancer.Methods Sixty-five patients were randomized to receive traditional protocol and laparoscopic surgery（routine group,n=32）,and ERAS concept-guided laparoscopic surgery（observation group,n=33）.ALB,PRE,TRF,RbP and Hb were tested before and 1,3 and 7 days after operation.The ratio of body weight 1,3,7 and 30 days after operation to the body weight before the operation（WR）was monitored,and comparative analyses were performed.Results There was no significant difference in preoperative indexes.On the first day after operation,the indexes in the two groups were lower than those before operation,but there was no significant difference between the two groups（P〉0.05）.The levels of ALB,PRE and TRF increased gradually in the two groups after operation.As compared with the conventional group,the levels of ALB（38.6±2.0g/L）and PRE（192.2±16.1 mg/L）in the observation group were significantly increased on the postoperative day7（P〉0.05）.On the postoperative day 1 and 3,the level of RbP was lower than that before operation（P〉0.05）,but there was no significant difference in the level of RbP in the observation group before and after the operation.The postoperative Hb levels were lower than those preoperation（P〈0.05）in two groups.On the postoperative day 7,Hb levels in the two groups were restored to the preoperative levels and the level of Hb between the two groups（109.4±7.11 g/L vs.108.7±8.11 g/L）showed no statistically significant difference.In the two groups,the postoperative WR was decreased gradually,and WR in the routine group（0.93±0.053）was lower than that in the observation group（0.96±0.028）on the postoperative day 7（P〈0.05）.Conclusions The application of ERAS concept in laparoscopic radical gastrectomy can maintain postoperative nutritional status.