摘要
目的探讨胃癌患者行3D腹腔镜根治性全胃切除术后早期经口进食的安全性、可行性及近期临床效果。方法回顾性收集本院2017年3月-2018年3月收治并行3D腹腔镜根治性全胃切除术的胃癌患者临床资料,根据术后经口进食时间,分为早期经口进食组(术后第1天)和常规进食组(经肛门排气后),并根据性别、年龄、体质量指数、TNM分期和肿瘤分化程度进行严格配对,匹配后共134例患者纳入分析,其中早期经口进食组和常规进食组各67例。比较两组患者术后胃肠功能恢复时间、术后早期营养状况、经口进食耐受情况及术后并发症发生率。结果与常规进食组相比,早期经口进食组术后首次排气时间[(2.66±1.38) d vs (3.37±1.19) d,P=0.000]和首次排便时间[(3.46±1.41) d vs (4.52±1.26) d,P=0.012]更早;术后住院时间更短[(6.51±1.53) d vs (8.62±1.48) d,P=0.000],住院费用更少[(1.74±0.51)万元vs (2.12±0.83)万元,P=0.012];术后第6天血清前白蛋白水平[(177.6±33.1) mg/L vs (149.4±25.3) mg/L,P=0.016]及血清白蛋白水平[(37.3±3.1) g/L vs(34.1±3.5) g/L,P=0.011]更高;两组术后重新置入鼻胃管率及吻合口瘘等并发症发生率均无统计学差异(P均> 0.05)。结论胃癌患者3D腹腔镜根治性全胃切除术后早期经口进食能够促进肠道功能恢复,改善术后营养状态,减少住院时间和住院费用,不增加术后并发症发生率,是安全可行的。
Objective To explore the safety and feasibility of early oral feeding after 3D laparoscopic radical total gastrectomy for patients with gastric cancer. Methods Clinical and pathological data about 134 patients who underwent 3D laparoscopic radical total gastrectomy in department of general surgery, Chinese PLA General Hospital from March 2017 to March 2018 were analyzed retrospectively. Cases were divided into early oral feeding group and routine feeding group and matched by sex, age, body mass index(BMI), TNM stage and tumor differentiation degree, with 67 in each group. Recovery time of gastrointestinal function, postoperative nutritional status, tolerance of oral feeding and postoperative complications were compared between the two groups. Results Compared with routine feeding group, patients in early oral feeding group had significantly shorter time to postoperative first flatus [(2.66±1.38) d vs(3.37±1.19) d, P =0.000], time to first defecation [(3.46±1.41) d vs(4.52±1.26) d, P =0.012], less postoperative hospitalization [(6.51±1.53) d vs(8.62±1.48) d, P =0.000] and lower hospitalization expenses [(1.74±0.51) thousand yuan vs(2.12±0.83) thousand yuan, P =0.012 ]. At 6 days after operation, serum prealbumin level [(177.6±33.1) mg/L vs(149.4±25.3) mg/L, P=0.016] and serum albumin level [(37.3±3.1) g/L vs(34.1±3.5) g/L, P=0.011] were higher in early oral feeding group. There was no significant difference in the incidence of postoperative complications between the two groups(all P〉0.05). Conclusion Early oral feeding after 3D laparoscopic radical gastrectomy can promote the recovery of gastrointestinal function, improve nutritional status, reduce length of hospital stay and hospital expenses and it does not increase the incidence of postoperative complications, which is safe and feasible for gastric cancer patients.
作者
鲁意迅
邱兆岩
谢天宇
崔建新
王鑫鑫
卫勃
陈凛
LU Yixun;QIU Zhaoyan;XIE Tianyu;CUI Jianxin;WANG Xinxin;WEI Bo;CHEN Lin(Department of General Surgery,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
2018年第9期791-795,共5页
Academic Journal of Chinese PLA Medical School
关键词
胃癌
3D腹腔镜手术
早期经口进食
gastric cancer
3D laparoscopic surgery
early oral feeding