快通道外科技术联合腹腔镜在老年患者胃癌根治术中的应用研究

Application of fast track surgery combined with laparoscopy in radical gastrectomy of elderly patients

目的探讨快通道外科技术(FTS)联合腹腔镜胃癌根治术对老年胃癌的疗效及安全性。方法根据随机数字表法将80例确诊为胃癌的老年患者随机分为4组,每组各20例:A组(FTS+腹腔镜组);B组(FTS+开腹组);C组[(常规围手术期处理(CPC)+腹腔镜组)];D组(CPC+开腹组)。观察指标包括术中指标、术后恢复指标、营养状况指标及全身应激反应指标。结果各组术中出血量比较差异有统计学意义(F=55.461,P=0.000),腹腔镜手术患者(A组和C组)较开腹手术患者(B组和D组)术中出血量少;各组手术切口长度差异有统计学意义(F=63.226,P=0.000),腹腔镜手术患者(A组和C组)较开腹手术患者(B组和D组)手术切口长度短。A组患者术后首次排气时间及术后住院时间最短,总治疗费用最低(P<0.05)。各组患者术后第1天血清白蛋白、前白蛋白及转铁蛋白较术前均降低(P<0.05),C反应蛋白(CRP)和白细胞介素6(IL-6)水平升高(P<0.05),术后第4~7天,所有患者的各项指标逐渐恢复,与其他各组比较,A组各指标恢复最快(P<0.05)。结论 FTS技术联合腹腔镜手术可改善老年胃癌患者术后早期营养状况,更有效地减少术后应激反应,可使患者术后更快恢复。

Objective To investigate the efficacy and safety of fast track surgery （FTS） combined with laparoscopic radical gastrectomy for elderly patients with gastric cancer. Methods A total of 80 elderly patients with gastric cancer were selected from September 2014 to August 2016, and randomly divided into four groups： [FTS ＋ laparoscopic group （group A,n = 20）], [FTS ＋ laparotomy group （group B,n = 20）], [conventional perioperative care （CPC）＋laparotomy group （group C, n=20）] and [CPC＋laparoscopic group （group D, n=20）]. Indexes including intraoperative index, postoperative recovery index, nutritional status index and systemic stress response index were observed. Results The intraoperative blood loss between the groups was significantly different （ F= 63.226,P = 0.000）. Laparoscopic surgery patients （group A and C） had significantly less blood loss during surgery than laparotomy patients （group B and D） （ P〈0.05）. The incision length of each group was significantly different （ F=55.461, P=0.000）. The incision lengths of laparoscopic surgery patients （group A and C） were significantly shorter than those of laparotomy patients （group B and D）. Patients in group A had the shortest postoperative first exhaust time and postoperative hospital stay, and the total hospitalization expenses of them were the lowest （ P〈0.05）. Serum albumin, prealbumin and transferrin were significantly decreased on the first postoperative day （ P〈0.05）, CRP and IL-6 levels were significantly increased （ P〈0.05）. From 4th to 7th postoperative day, the indexes of all the patients gradually returned to normal. Compared with other groups, the indexes of group A were the fastest to be normal （ P〈 0.05）. Conclusions FTS combined with laparoscopy can improve the early postoperative nutritional status of elderly patients with gastric cancer and reduce postoperative stress more effectively, which can shorten recovery time after surgery.