加速康复外科联合中医药对腹腔镜全直肠系膜切除术患者手术指标和临床效果的影响

Influence of Enhanced Recovery after Surgery Combined with Traditional Chinese Medicine on Surgical Indexes and Clinical Effects of Patients with Laparoscopic Total Mesenteric Resection

目的:分析加速康复外科(ERAS)联合中医药对腹腔镜全直肠系膜切除术患者手术指标和临床效果的影响。方法:选取2014年1月至2016年10月溧阳市中医医院收治的直肠癌患者128例作为研究对象,按不同治疗方式分组,Ⅰ组予以传统开腹全直肠系膜切除术治疗,Ⅱ组予以ERAS联合腹腔镜全直肠系膜切除术治疗,Ⅲ组予以ERAS、中医药联合腹腔镜全直肠系膜切除术治疗。比较各组手术情况,应激指标,炎性反应,免疫功能,并发症和预后情况比较。结果:Ⅱ组及Ⅲ组手术时间均多于Ⅰ组,Ⅲ组出血量、肛门排气时间、进食时间及住院时间均少于Ⅱ组及Ⅰ组,差异有统计学意义(P<0.05),各组淋巴结清扫数目、肿瘤下缘距离远切缘距离比较,差异无统计学意义(P>0.05)。术后,各组应激指标、炎性反应指标水平均上升,Ⅲ组炎性反应指标水平均低于Ⅱ组且低于Ⅰ组(P<0.05)。各组CD3+、CD4+、CD4+/CD8+水平均下降,Ⅲ组CD3+、CD4+、CD4+/CD8+水平均高于Ⅱ组且高于Ⅰ组,差异有统计学意义(P<0.05)。Ⅱ组及Ⅲ组并发症发生率低于Ⅰ组(P<0.05),Ⅱ组及Ⅲ组比较差异无统计学意义(P>0.05)。各组预后情况比较差异无统计学意义(P>0.05)。结论:ERAS联合中医药在腹腔镜全直肠系膜切除术患者的应用中优越性明显,可减轻机体创伤性,维持内环境稳定,为其临床推广提供理论依据。

Objective:To analysis the influence of the enhanced recovery after surgery(ERAS)combined traditional Chinese medicine on the surgical indexes and clinical effects on patients with laparoscopic total mesenteric resection.Methods:A total of 128 patients with rectal cancer in Liyang Traditional Chinese Medicine Hospital,from January 2014 to October 2014 were selected.According to the different treatment group,Ⅰgroup was treated with traditional open-abdominal total mesenteric resection,and groupⅡwas treated with ERAS,TCM combined laparoscopic total mesenteric resection.Ⅲgroup was treated with ERAS,TCM,combined with laparoscopic total mesenteric resection.The surgical conditions,stress indicators,inflammatory responses,immune function,complications and prognosis in each group were compared.Results:operation time inⅡgroup andⅢgroup was higher thanⅠgroup,and the bleeding,anal exhaust time,feeding time and hospital stay inⅢgroup was lesser thanⅡandⅠgroup.There was a statistical difference(P<0.05).There were no statistical difference in the number of lymph node dissection,tumor margin from the far edge of the distance in each group(P>0.05).After surgery,the stress index,inflammation index level in each group were lower thanⅡandⅠgroup(P<0.05).CD3+,CD4+,CD4+/CD8+levels inⅢgroup were all decreased,CD3+,CD4+,CD4+/CD8+levels inⅡgroup andⅢgroup were higher thanⅠgroup and there was a statistical difference(P<0.05).Complication rates inⅢgroup andⅡgroup were lower thanⅠgroup(P<0.05).There were no statistical difference in prognosis in each group(P>0.05).Conclusion:ERAS combined with traditional Chinese medicine in the application of patients with laparoscopic total mesenteric resection has obvious advantages and can reduce traumatic body and maintain stable internal environment,providing theoretical basis for its clinical promotion.