快速康复模式下腹腔镜结直肠癌术后短期康复指标分析

Analysis of short-term recovery indicators of enhanced recovery after laparoscopic colorectal cancer surgery

目的比较在传统围手术期诊疗与快速康复模式下,腹腔镜结直肠癌患者的短期康复指标异同,分析快速康复模式对结直肠外科的意义。方法收集2015年6月~2017年04月在吉林大学第二医院就诊的117例结直肠癌患者,随机数表法分为传统组和快速康复组。两组均采用腹腔镜手术方式,快速康复组采取术前宣教,镇痛管理、早期经口进食,早期活动等快速康复措施,传统组按照传统方式管理,观察两组患者术后胃肠功能恢复时间、并发症发生率、术后住院天数、住院费用等指标。结果两组患者的性别比例(χ~2=0.04,P>0.05)、年龄(t=0.65,P>0.05)、BMI指数(t=0.08,P>0.05)、肿瘤位置(χ~2=0.41,P>0.05)及手术时间(t=0.40,P>0.05)均无明显差异。传统组患者和快速康复组患者术后住院天数(t=2.66,P<0.05)、术后首次排气时间(t=2.78,P<0.05)、首次排便时间(t=2.54,P<0.05)、进全流食时间(t=6.95,P<0.05)差异均有统计学意义。总住院天数、住院费用差异无统计学意义。传统组发生不良反应28人次,快速康复组发生不良反应13人次,两组发生咽部不适的差异有统计学意义(χ~2=9.17,P<0.05),并发症发生率无明显差异。术后住院时间方面,Dixon联合回肠末端造口术治疗的直肠癌患者与单纯Dixon术式治疗的直肠癌患者相比明显缩短(t=2.55,P<0.05)。结论快速康复模式明显缩短住院时间,且未对患者造成额外的经济负担;医患配合度更高,有利于医疗过程的顺利开展;快速康复组康复进程加快,部分并发症与不良反应发生率降低;Dixon联合回肠末端造口术可缩短直肠癌患者住院时间。应重视快速康复模式中各个环节的实施,以积少成多,达成整个康复过程的加速完成。

Objective This paper compared the short-term recovery indicators of laparoscopic colorectal cancer patients with enhanced recovery after surgery(ERAS)and traditional perioperative care,and analyzed the efficiency of enhanced recovery after surgery for colorectal surgery.Methods This study included117cases who had been diagnosed with colorectal cancer and underwent surgical treatment in our hospital during June2015to April2017.The patients were randomly divided into two different groups,and both did surgery in a laparoscopic way.The enhanced recovery after surgery group took perioperative rehabilitation measures consisting of preoperative education,analgesia management,early oral feeding,early activity,and so on.On the contrary,the traditional group took care of patients in the conventional way.This study investigated indicators such as postoperative recovery time of gastrointestinal function,incidence of adverse reactions and complications,hospitalization time and expense.Results There was no significant difference between the two groups in gender(χ2=0.042,P>0.05),age(t=0.65,P>0.05),BMI(t=0.08,P>0.05),tumor location(χ2=0.41,P>0.05)and operation time(t=0.40,P>0.05).It was statistically different between traditional group and ERAS group in several aspects including postoperative hospitalization time(t=2.66,P<0.05),postoperative exhaust time(t=2.78,P<0.05),first defecation time(t=2.54,P<0.05),liquid diets time(t=6.95,P<0.05).However,there was no significant difference in total hospitalized time and cost.The number of adverse reactions in the traditional group was28while in ERAS group was13.The difference between the two groups of pharyngalgia was statistically significant(χ2=9.17,P<0.05).The complications incidences of the two group had no significant difference.The postoperative hospitalization time of the rectal carcinoma patients who underwent Dixon joint terminal ileum stoma was significantly shorter than those who had Dixon only(t=2.55,P<0.05).Conclusion ERAS significantly reduces hospital stay and does not cause additional financial burden to patients.The degree of doctor-patient cooperation is increased so that the medical treatment process has been carried out smoothly.ERAS group indicates an accelerated recovery with reduced frequency of complications and adverse effects.For rectal cancer patients,Dixon joint terminal ileum stoma shortens the hospitalization time.The implementation of eachlink in enhanced recovery after surgery should be taken seriously.As a result,the recovery process would be completed quicker.