加速康复外科理念在腹腔镜低位直肠癌前切除术患者中的应用效果分析

Effect of enhanced recovery after surgery in laparoscopic anterior resection for low rectal cancer

目的探讨加速康复外科(ERAS)理念应用于腹腔镜低位直肠癌前切除术中的临床治疗效果。方法选取2017年10月至2019年2月本院胃肠结直肠外科收治且行腹腔镜辅助下低位直肠癌根治术的110例患者作为研究对象,随机将患者分成ERAS组(n=56)与常规组(n=54),ERAS组在围手术期行加速康复外科管理,对照组在围手术期行传统方式管理。比较两组营养指标水平、应激反应指标水平及术后康复情况。结果术前,两组转铁蛋白(TRF)、白蛋白(ALB)、前白蛋白(PRE)、视黄醇结合蛋白(RbP)水平比较,差异均无统计学意义(均P>0.05);术后,两组上述指标低于组内术前,常规组低于ERAS组,差异均有统计学意义(均P<0.05)。术前,两组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、促肾上腺皮质激素(ACTH)水平比较,差异均无统计学意义(均P>0.05);术后,两组上述指标高于组内术前,常规组CRP、TNF-α、ACTH高于ERAS组,差异均有统计学意义(均P<0.05)。ERAS组患者术后肠道通气时间早于常规组,住院天数、住院费用少于常规组,差异均有统计学意义(均P<0.05)。两组术后恶心呕吐、切口感染、吻合口漏等术后不良反应及并发症发生率比较,差异均无统计学意义(均P>0.05)。结论加速康复外科理念应用于腹腔镜低位直肠癌前切除术患者的管理有积极的作用,有助于促进患者术后恢复,对于改善患者营养状态及减轻手术应激也有一定的效果。

Objectives To investigate the effect of enhanced recovery after surgery (ERAS) in laparoscopic anterior resection for low rectal cancer. Methods One hundred and ten patients treated with laparoscopic radical resection of low rectal cancer in the Department of Gastrointestinal & Colorectal Surgery in our hospital between October 2017 and February 2019 were recruited. Patients were randomly assigned to ERAS group (n = 56) and the routine group (n = 54). Patients in the ERAS group received care based on ERAS principles, and patients in the routine group received routine care during perioperative period. The follow ing were compared between the two groups: nutritional indices, indices of stress reaction and postoperative recovery. Results The levels of transferring (TRF), albumin (ALB), and prealbumin (PRE), and retinol-binding protein (RbP) did not differ between groups before surgery (P > 0.05). All of them decreased significantly after surgery in both groups and were significantly lower in the routine group than in the ERAS group (P < 0.05). C-reactive protein (CRP), tumor necrosis factor-α(TNF-α), interleukin-6 and adrenocorticotropic hormone (ACTH) did not differ between groups before surgery (P >0.05). These increased significantly af ter surgery in both groups, and CRP, TNF-α, and ACTH were significantly higher in the routine group than in the ERAS group (P < 0.05). Compared with theroutine group, ERAS group had shorter time to flatulence, shorter hospitalization, and lower hospi talization expenses (P < 0.05). There was no between-group difference in incidence of nausea & vomiting, wound infection, and anastomotic leakage (P > 0.05). Conclusion The concept of ERAS had a positive effect in the perioperative care in patients re ceiving laparoscopic anterior resection for low rectal cancer. It could promote patients’recovery, improve their nutritional status and alleviate stress response after surgery.