快速康复外科理念在腹腔镜结直肠癌根治术患者中的应用效果分析

Effect of enhanced recovery after surgery pathway in the management of patients with laparoscopic radical operation of colorectal cancer

目的探讨快速康复外科理念在腹腔镜结直肠癌根治术患者中的应用效果。方法选择2015年5月至2016年5月于本院接受腹腔镜结直肠癌根治术的77例为对照组,采用全身麻醉,应用传统康复理念管理;选择2016年9月至2017年9月于本院接受腹腔镜结直肠癌根治术的73例患者为观察组,采用硬膜外阻滞麻醉复合全身麻醉,同时应用快速康复理念管理。比较两组手术相关指标、术后恢复指标、手术前后营养指标、胰岛素敏感性及术后并发症情况。结果两组患者手术时间差异无统计学意义(P>0.05);观察组术中出血量少于对照组,差异有统计学意义(P<0.05)。观察组患者尿管留置时间、首次排便时间、开始进半流食时间、下床时间以及住院时间均短于对照组,差异均有统计学意义(均P<0.05)。两组术前白蛋白、前白蛋白以及总蛋白水平差异均无统计学意义(均P> 0.05),观察组术后7 d白蛋白、前白蛋白及总蛋白水平与组内术前差异均无统计学意义(均P> 0.05),对照组术后7 d白蛋白、前白蛋白及总蛋白水平低于组内术前及同期观察组,差异均有统计学意义(均P<0.05)。两组术前胰岛素敏感性差异无统计学意义(P> 0.05);观察组术后7 d胰岛素敏感性和恢复率均高于对照组,差异均有统计学意义(均P<0.05)。观察组术后7 d并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论与传统的康复管理理念相比,快速康复外科理念应用于腹腔镜结直肠癌根治术患者具有一定的减轻患者机体应激及减少术后并发症的优势,有助于患者术后恢复。

Objective To investigate the effect of enhanced recovery after surgery pathway in the management of patients with laparoscopic radical operation of colorectal cancer. Methods 77 patients who were treated in our hospital with laparoscopic radical operation of colorectal cancer from May 2015 to May 2016 were recruited as the control group. They were treated with general anesthesia and managed with traditional recovery pathway. 73 patients who were treated in our hospital with laparoscopic radical operation of colorectal cancer from September 2016 to September 2017 were recruited as the treatment group. They were treated with epidural block anesthesia plus general anesthesia and managed with enhanced recovery after surgery pathway. Indices related to operation and postoperative recovery, indices related to nutritional status before and after operation, insulin sensitivity and incidence of postoperative complications were compared between the two groups. Results Duration of operation was similar between the two group （P 〉 0.05）. Amount of intraoperative blood loss was significantly less in the treatment group than in the control group （P 〈 0.05）. Duration of catheter retention, time to first defecation, time to semi-fluid intake, time to off-bed activities, and duration of hospitalization were all significantly shorter in the treatment group than in the control group （P 〈 0.05）. Before operation, there was no significant difference in albumin, prealbumin and total protein levels between the two groups （P 〉 0.05）. In the treatment group, there was no significant change in albumin, prealbumin and total protein levels before and 7 days after operation （P 〉 0.05）. In the control group, albumin, prealbumin and total protein levels 7 days after operation were significantly lower than before operation and significantly lower than in the treatment group （P 〈 0.05）. There was no significant difference in insulin sensitivity between the two groups before operation （P 〉 0.05）. Insulin sensitivity 7 days after operation and recovery rate were significantly higher in the treatment group than in the control group （both P 〈 0.05）. Incidence of postoperative complications was significantly lower in the treatment group than in the control group（P 〈 0.05）. Conclusion In patients with laparoscopic radical operation for colorectal cancer, compared with traditional recovery pathway, enhanced recovery after surgery pathway could reduce systemic stress and postoperative complications. It could promote postoperative recovery.