加速康复外科应用于全腹腔镜下远端胃癌D2根治术的价值及对炎症因子的影响

Value of enhanced recovery after surgery in D2 radical resection of distal gastric cancer under total laparoscopy and its effect on inflammatory factors

目的探讨加速康复外科(ERAS)理念在全腹腔镜下远端胃癌D2根治术中的应用价值及对炎症因子的影响。方法回顾性分析陕西省汉中市中心医院2016年3月至2017年10月收治的50例远端胃癌患者资料,其中观察组25例在ERAS理念指导下行全腹腔镜远端胃癌D2根治术,对照组25例在传统理念指导下行全腹腔镜远端胃癌D2根治术。比较两组患者围术期相关指标、术后恢复情况及术后炎症指标的变化。结果50例患者均顺利完成手术。观察组的手术时长为(287.2±52.3)min,淋巴结清扫数目为(34.0±11.0)枚,对照组的手术时长为(296.8±57.9)min、淋巴结清扫数目为(34.6±14.3)枚,两组手术时长及淋巴结清扫数目差异均无统计学意义(均P>0.05);观察组的住院时长为(22.0±2.8)d,住院费用为(61044.4±4692.7)元,下床开始活动时间为术后(12.8±1.8)h,对照组的住院时长为(23.9±1.9)d,住院费用为(63875.81±4392.6)元,下床开始活动时间为术后(23.7±8.2)h,两组差异均有统计学意义(均P<0.05)。观察组和对照组术后第1天疼痛评分分别为(5.0±0.8)分和(6.4±1.0)分,第4天分别为(2.7±0.9)分和(3.9±0.9)分,差异均有统计学意义(均P<0.05),两组第7天疼痛评分差异无统计学意义(P>0.05)。两组患者术前1天肿瘤坏死因子α、白细胞介素6、C反应蛋白、降钙素原水平差异均无统计学意义(均P>0.05),而术后第1、4、7天,观察组4个因子水平均低于对照组,差异均有统计学意义(均P<0.05)。结论ERAS应用于全腹腔镜下胃癌根治术可改善患者术后状态,明显降低患者的炎症反应,对提高患者生命质量有一定价值。

Objective To investigate the value of enhanced recovery after surgery(ERAS)in D2 radical resection of distal gastric cancer under total laparoscopy and its effect on inflammatory factors.Methods The clinical data of 50 patients with distal gastric cancer at Hanzhong Central Hospital from March 2016 to October 2017 were retrospectively analyzed.The patients were divided into the observation group(25 cases)and the control group(25 cases).The observation group received totally laparoscopic radical D2 gastrectomy for distal gastric cancer under the guideline of ERAS;the control group received totally laparoscopic radical D2 gastrectomy for distal gastric cancer under the guideline of the traditional method.The changes of perioperative related indexes,postoperative recovery and postoperative inflammatory indexes were compared between the two groups.Results All 50 patients successfully completed the operation.The operation time was(287.2±52.3)min and(296.8±57.9)min,respectively of the observation group and the control group;the number of lymph node dissection was(34.0±11.0)and(34.6±14.3),respectively of the observation group and the control group.There were no significant differences in the above indexes between the two groups(all P>0.05).The hospitalization time,the hospitalization cost,the postoperative time of getting out of bed of the observation group was(22.0±2.8)d,(61044.4±4692.7)yuan,(12.8±1.8)h.The hospitalization time,the hospitalization cost,the postoperative time of getting out of bed of the control group was(23.9±1.9)d,(63875.81±4392.6)yuan,(23.7±8.2)h.And there were statistically significant differences between the two groups(all P<0.05).The pain score on the 1st day was(5.0±0.8)score and(6.4±1.0)score,and on the 4th day was(2.7±0.9)score and(3.9±0.9)score,respectively of the observation group and the control group,and there was a statistical difference(all P<0.05).There was no statistical difference in the 7th day pain score between the two groups(P>0.05).There were no statistically significant differences in the tumor necrosis factorα,interleukin-6(IL-6),C-reactive protein and procalcitonin on the day before the operation of both groups(all P>0.05);the levels of above four factors in the observation group were lower than those in the control group on the 1st,4th and 7th day after the operation,and the differences were statistically significant(all P<0.05).Conclusion The application of ERAS in totally laparoscopic radical resection of gastric cancer can improve the postoperative condition,significantly reduce the inflammatory reaction of patients,which has a certain value of improving the quality of life of patients.