胃间质瘤的围手术期加速康复治疗

Enhanced postoperative recovery for laparoscopic resection of gastirc gastrointestinal stromal tumors

目的探讨腹腔镜优势部位胃间质瘤患者围手术期应用加速康复外科（enhanced recovery after surgery, ERAS）治疗的安全性和有效性。方法对2015年3月至2017年1月期间上海交通大学医学院附属仁济医院收治的86例腹腔镜优势部位胃间质瘤患者进行回顾分析，分为ERAS组44例。传统组42例，比较两组患者围手术期临床资料及术后恢复情况。结果与传统组相比，ERAS组术后首次排气时间提前[（36．5±3．8）h比（48．5±4．1）h，P〈0．01]，术后首次排便时间提前[（44．2±6．7）h比（57．2±9．1）h，P〈0．01]，术后经口进食时间提前[（1．1±0．2）d比（2．4±0．3）d，P〈0．01]，术后下床时间提前[（1．3±0．5）d比（2．9±1．1）d，P〈0．01]，术后住院时间缩短[（4．2±2．1）d比（5．9±2．8）d，P〈0．01]，术后疼痛减轻[（3．1±3．0）分比（5．2±3．2）分，P〈0．05）]。ERAS组术后1d血糖和胰岛素抵抗水平较传统组降低[（6．7±1．1）mmol／L比（9．8±1．7）mmol／L，（d．0±7．5）比（9．5±2．2），均P〈0．05]。ERAS组和传统组术后总体并发症发生率为4．5％和4．7％，差异无统计学意义（χ^2=0．46，P〉0．05）。结论对腹腔镜胃间质瘤手术患者在围手术期应用ERAS理念可以促进术后康复，明显缩短患者住院时间。

Objective To investigate the efficacy and safety of the enhanced recovery after surgery （ERAS） protocol in patients with gastric gastrointestinal stromal tumors （GISTs） in favorable sites. Methods Between March 2015 and January 2017, 86 gastric GISTs patients undergoing laparoscopic resection in favorable sites were retrospectively analyzed. The patients were divided into ERAS protocol group （n = 44 ） and conventional protocol group （n = 42 ）. Perioperative data and postoperative recovery parameters were compared. Results Compared with conventional group, postoperative recovery parameters in ERAS group such as time to first flatus , the first defecation, return to normal diet, physical activity out- of-bed, and the hospital stay were obviously shortened. The postoperative pain score [ （ 3.1 ± 3.0 ） vs. （5.2±3.2）, P 〈0.05] and insulin resistance [（4.0 ±7.5） vs. （9.5 ±2.2）, P 〈0.05] were significantly reduced in the ERAS protocol group than in the conventional protocol group. However, no statistically significant differenees were observed in terms of operation time and intraoperative blood loss （ P 〉 0. 05 ）. There were no martality in both groups. The postoperative complieations were 4. 5% and 4.7% respeetively. Conclusion Laparoscopic technique in favorable sites combined with the ERAS protocol enhance postoperative recovery and shorten hospital stay in gastric GIST patients.