ERAS在腹腔镜胃癌患者围手术期管理中的应用

ERAS protocol in the management of laparoscopic gastrectomy for gastric cancer

目的探讨促进术后恢复方案(Enhanced Recovery After Surgery,ERAS)在胃癌患者围手术期管理中的应用效果。方法回顾性分析2012年1月~2016年10月期间在我院行腹腔镜胃癌根治术的95例患者的临床病理资料。依据是否应用ERAS方案,将患者分为促进术后恢复方案组(GC-ERAS组)与对照组(GC组)。倾向评分匹配得到GC-ERAS组20例和GC组40例患者。比较两组患者的临床病理资料、并发症发生率及术后恢复情况等。结果GC-ERAS组较GC组鼻胃管放置率低(P<0.01),进食时间缩短(P<0.001),住院时间短(P<0.05);两组之间并发症发生率和30天再入院率差异均无统计学意义(P>0.05)。结论GC-ERAS方案的实施在腹腔镜胃癌患者管理中,可降低鼻胃管放置率和腹腔引流管放置率,可缩短患者住院时间和经口摄食时间,而不增加手术后并发症,可促进胃癌患者术后康复。

Objective Enhanced Recovery After Surgery (ERAS) has been applied to perioperative management of a variety of clinical tumors.The purpose of this study was to observe the effects of ERAS protocol in patients with gastric cancer.Methods The clinical and pathological data of patients with gastric cancer treated from January 2012 to October 2016 were retrospectively analyzed.Patients were divided into ERAS group (GC-ERAS group) and control group (GC).Propensity score matching is used to adjust age,gender,number of comorbidities,body mass index,tumor stage,distal and total gastrectomy.Patients clinical,pathological characteristics,postoperative complications,postoperative recovery between the two groups were compared.Results 95 patients were included in this study,20 patients in the GC-ERAS group and 40 patients in the GC group were matched.Nasogastric tube placement rate (35% vs.100%,P <0.001) in the GC-ERAS group were lower than those in the GC group,Fasting time ( P <0.001) and hospital stay was shorter (8.5 vs.10.8 days,P =0.01) in GC-ERAS group.There were similar complications between the two groups and a 30-day readmission rate.Conclusion The implementation of GC-ERAS significantly promoted postoperative recovery in patients with gastric cancer.This conclusion requires further prospective studies.