快速康复外科策略下腹腔镜右半结肠癌根治术在高龄结肠癌患者中的应用

Clinical application of fast track surgery in laparoscopic right hemicolectomy for elderly patients with colon cancer

目的探讨快速康复外科(FTS)策略下腹腔镜右半结肠癌根治术在高龄结肠癌患者中的应用效果。方法回顾性分析2013年1月至2016年1月78例高龄结肠癌患者的临床资料,按照治疗方式将患者分为FTS组与对照组,每组各39例。FTS组围手术期给予快速康复方案治疗,对照组给予常规治疗。采用SPSS22.0软件进行统计学分析。围手术期相关指标及应激反应指标等计量资料以(±s)表示,采用独立t检验;术后并发症发生率、患者满意率等计数资料以例数和%表示,组间比较采用χ~2检验,P<0.05为差异有统计学意义。结果两组患者手术时间、术中出血量及淋巴结清扫数目比较差异均无统计学意义(P>0.05)。FTS组患者术后首次排气时间、下床活动时间、恢复饮食时间以及平均住院时间均明显短(少)于对照组(P<0.05)。FTS组术后应激反应情况明显优于对照组(P<0.05);FTS组术后并发症发生率12.8%(5/39)明显低于对照组35.8%(14/39);FTS组术后满意率66.7%(26/39),明显高于对照组38.4%(15/39),差异具有统计学意义(χ~2=6.221,P=0.013)。结论快速康复外科策略下腹腔镜右半结肠癌根治术在高龄结肠癌患者的应用有利于降低应激反应,促进老年患者术后康复,提高患者治疗满意度。

Objective To investigate the clinical outcome of of fast track surgery in laparoscopic right hemicolectomy for elderly patients with colon cancer. Methods From January 2013 to January 2016,clinical data of 78 elderly patients with colon cancer were analyzed retrospectively,who were divided into FTS group（ 39 cases） and control group（ 39 cases）. Patients in control group received conventional perioperative treatment and patients in FTS group received perioperative management according to fast track surgery. All data were analyzed by using SPSS 22. 0 software. The postoperative complication rate and satisfaction rate were analyzed by Chi-square test. Perioperative measurement data and stress index were expressed as（ ± s）,and were examined by using t test. A P value 0. 05 was considered as statistically significant difference. Results There were no significant differences between two groups in terms of operation time,intraoperative blood loss and harvested lymph nodes（ P〉 0. 05）. The first flatus time,ambulation time,diet recovery time,hospital stay of the FTS group were significantly shorter or less than those of the control group（ P 〈0. 05）. Stress index in the FTS group were significantly better than that of the control group（ P 〈0. 05）; the postoperative complication rate of the FTS group was 12. 8%（ 5/39） which was significantly lower than 35. 8%（14/39） of the control group; the satisfaction rate of the FTS group was66. 7%（26/39） which was significantly higher than 38. 4%（15/39） of the control group（ χ~2= 6. 221,P =0. 013）. Conclusion The clinical application of FTS in elderly patients with colon cancer is helpful to reduce the stress response,to promote postoperative rehabilitation and to improve the patient satisfaction.