局部进展期胃癌患者新辅助化疗后围手术期的临床观察

Perioperative characteristics of patients with locally advanced gastric cancer receiving preoperative neoadjuvant chemotherapy

目的 比较腹腔镜根治性手术术前接受与未接受新辅助化疗的局部进展期胃癌患者的临床资料,探讨接受新辅助化疗后腹腔镜根治性手术患者的临床观察重点及护理要点。方法 收集2016-2017年本院接受新辅助化疗后手术的局部进展期胃癌患者（新辅助化疗后手术组） 31例及直接接受根治性手术的局部进展期胃癌患者（直接手术组） 48例,比较两组年龄、术前体质量指数（BMI）、术前血红蛋白（Hb）、术前白细胞计数（WBC）、术前白蛋白（Alb）、围手术期平均收缩压（SBP）、术中出血量、手术时间、术后第1天（D1）尿量、术后第1天（D1）腹腔引流量、术后平均住院时间等临床资料,分析两组间差异与近期疗效的相关性,总结接受新辅助化疗后手术患者的围手术期特点。结果 本研究纳入79例局部进展期胃癌患者,新辅助化疗后手术组平均年龄59. 06岁,直接手术组平均年龄57. 96岁,两组比较差异无统计学意义。新辅助化疗后手术组术前BMI[（22. 23±1. 85） vs （23. 77±1. 57） kg/m^2,P 〈0. 01]、Hb水平[（113. 19±23. 24） vs （126. 10±27. 06） g/L,P=0. 027]及WBC水平[（4. 79±1. 38）×10^9/L vs （5. 87±2. 17）×10^9/L,P=0. 008]均较直接手术组低,而术后第1天腹腔引流量[（319. 58±249. 90） vs （181. 29±137. 16） m L,P=0. 002]较直接手术组更多,术后住院时间[（12. 45±6. 12） vs （9. 35±2. 49） d,P=0. 002]较直接手术组更长,差异均有统计学意义。结论 接受新辅助化疗的患者较直接手术的患者营养状况、手术耐受性更差。早期营养状况改善、加强术后循环水平监测及处理等措施,可提高此类患者围手术期安全,利于术后康复。

Objective To compare the clinical and perioperative data of patients with locally advanced gastric cancer patients undergoing laparoscopic radical surgery with and without preoperative neoadjuvant chemotherapy and analyze the clinical management and nursing strategies for these patients. Methods We retrospectively analyzed the clinical data of 79 with locally advanced gastric cancer undergoing radical operation in our hospital between 2016 and 2017. Of these patients, 31 received neoadjuvant chemotherapy prior to laparoscopic radical surgery and 48 directly underwent the surgery without preoperative neoadjuvant chemotherapy. The perioperative characteristics, surgical data and outcomes of the patients were analyzed. Results The patients receiving preoperative neoadjuvant chemotherapy and those without neoadjuvant chemotherapy were matched for age at surgery （59.06 ± 11. 19 vs 57.96 ± 9.22 years, P 〉 0.05 ）. Compared with those without neoadjuvant chemotherapy, the patients receiving neoadjuvant chemotherapy before laparoscopic radical surgery had a significantly lower mean preoperative BMI （22.23±1.85 vs 23.77±1.57 kg/m2, P 〈 0. 001 ） , a lower preoperative hemoglobin level （ 113. 19 ± 23.24 vs 126.10 ± 27.06 g/L, P = 0. 027 ）, a lower preoperative white blood cell count [ （4.79± 1.38 ）× 10^9 vs （5.87 ± 2.17 ） × 10^9, P = 0. 008 ], a greater volume of abdominal drainage on the first day after the operation （ 319.58 ± 249.90 vs 181.29 ± 137.16 mL, P = 0. 002 ）, and a longer postoperative hospital stay （ 12.45 ± 6.12 vs 9.35 ± 2.49 d, P = 0. 002）. Conclusion Compared with those directly undergoing radical operation for locally advanced gastric cancer, the patients receiving preoperative neoadjuvant chemotherapy have poorer preoperative conditions in terms of nutrition, hemoglobin level, white blood cell count, and tolerance of surgery. Preoperative nutrition therapy, monitoring and timely interventions of blood perfusion level can help to improve the perioperative safety and promote postoperative recovery of these patients.