快速康复外科理念在腹腔镜结直肠癌经自然腔道标本取出手术中的应用

Effect of enhanced recovery in colorectal cancer patients undergoing laparoscopic natural orifice specimen extraction

目的探讨快速康复外科理念在腹腔镜结直肠癌经自然腔道标本取出手术中的应用效果。方法选取2013年5月至2017年10月山东省青岛市胶州中心医院拟行腹腔镜下结直肠癌根治术患者84例。应用随机数字表法将患者分为对照组和观察组,各42例。2组患者均接受腹腔镜结直肠癌经自然腔道标本取出手术,观察组围术期采用快速康复外科治疗方案,对照组围术期采用常规治疗方案。观察并比较2组患者的手术时间、术中出血量、术后首次排气时间、术后首次排便时间、住院时间、术后并发症情况。采用疼痛视觉模拟量表(VAS)评定镇痛情况,采用健康状况问卷评估生活质量。结果 5例患者因肿瘤较大经肠管无法取出,行辅助切口取出标本。最终对照组纳入研究对象39例,观察组40例。观察组患者的术后首次排气时间、术后首次排便时间、住院时间均短于对照组[(42±11)h比(50±9)h,(55±8)h比(59±6)h,(9.3±1.4)d比(10.4±2.1)d],差异均有统计学意义(均P<0.01);观察组术后第1天VAS评分低于对照组[(2.9±1.5)分比(3.6±1.3)分],差异有统计学意义(P<0.05);观察组术后总体不良反应及并发症的发生率低于对照组[42.5%(17/40)比64.1%(25/39)],差异有统计学意义(P=0.031);观察组术后第7天生理机能、躯体疼痛、精神健康评分均高于对照组,差异均有统计学意义(均P<0.05)。结论快速康复外科理念应用于腹腔镜结直肠癌经自然腔道标本取出手术有利于患者早期术后恢复。

Objective To investigate the effect of enhanced recovery after surgery（ERAS） on colorectal cancer patients undergoing laparoscopic natural orifice specimen extraction（NOSE）. Methods A total of 84 colorectal cancer patients undergoing laparoscopic NOSE from May 2013 to October 2017 in Jiaozhou Central Hospital of Qingdao were randomly divided into observation group and control group, with 42 cases in each group. The observation group was treated with ERAS therapy; the control group was treated with conventional therapy. Operation time, intraoperative blood loss volume, postoperative first exhaust time, first defecation time, hospital stay time and complications were observed. Analgesia effect was assessed using the Visual Analogue Scale（VAS）; quality of life was assessed using the SF-36 health survey questionnaire. Results Colorectal tumor could not be extracted through intestinal canal due to a large volume in 5 patients. First exhaust time, first defecation time and hospital stay time in observation group（n＝40） were significantly shorter than those in control group（n＝39）［（42±11）h vs （50±9）h， （55±8）h vs （59±6）h， （9.3±1.4）d vs （10.4±2.1）d］（P〈0.01）. The VAS score on the 1st day after operation in observation group was significantly lower than that in control group［（2.9±1.5） vs （3.6±1.3）］（P〈0.05）. Incidence of postoperative complications in observation group was significantly lower than that in control group［42.5%（17/40） vs 64.1%（25/39）］（P=0.031）. Scores of physiological function, body pain and mental health in observation group were significantly higher than those in control group（P〈0.05）. Conclusion ERAS therapy can promote postoperative recovery of patients with colorectal cancer NOSE surgery.