加速康复外科理念下腹腔镜远端胃癌根治术不放置腹腔引流管的临床研究

A clinical study on laparoscopic radical distal gastrectomy without abdominal drainage under the concept of enhanced recovery after surgery

目的:探讨加速康复外科理念下腹腔镜远端胃癌根治术不放置腹腔引流管的安全性及可行性。方法:回顾分析2018年6月至2019年6月收治的77例腹腔镜远端胃癌根治术患者的临床资料,术中40例留置腹腔引流管(引流组),37例未留置腹腔引流管(无管组),比较两组患者基线资料、手术效果及术后早期并发症情况。结果:两组患者基线资料、术后早期并发症差异无统计学意义。引流组与无管组术后早期VAS疼痛评分[(7.03±0.80)分vs.(6.30±1.02)分,P<0.01]、术后镇痛药使用剂量[(136.25±48.02)mL vs.(108.11±47.90)mL,P<0.05]、术后首次下床活动时间[(34.50±5.89)h vs.(28.38±5.22)h,P<0.01]、住院时间[(9.75±1.08)d vs.(8.84±1.17)d,P<0.01]、住院费用[(46681.33±2260.17)元vs.(44899.14±3324.70)元,P<0.05]、药占比[(25.09%±4.05%)vs.(22.36%±4.46%),P<0.01]差异有统计学意义(P<0.05),无管组均优于引流组。结论:腹腔镜远端胃癌根治术不放置腹腔引流管是安全、可行的,是具有经济效益的快速康复治疗措施。

Objective:To investigate the safety and feasibility of laparoscopic radical gastrectomy for distal gastric cancer without abdominal drainage under the concept of enhanced recovery after surgery.Methods:A retrospective analysis of clinical data was made for 77 patients who underwent laparoscopic radical gastrectomy for distal gastric cancer from Jun.2018 to Jun.2019.Drainage group comprised 40 cases with abdominal drainage and the tubeless group comprised 37 cases without abdominal drainage.The baseline information,operation outcomes and incidence of short-term postoperative complications were compared between the two groups.Results:There was no significant difference in the baseline information or short-term postoperative complications in the two groups.In terms of operation outcomes,the tubeless group was superior in early postoperative VAS pain score[(7.03±0.80)points vs.(6.30±1.02)points,P<0.01],dosage of analgesic drugs[(136.25±48.02)mL vs.(108.11±47.90)mL,P<0.05],the postoperative ambulation time[(34.50±5.89)h vs.(28.38±5.22)h,P<0.01],hospital stay[(9.75±1.08)d vs.(8.84±1.17)d,P<0.01],hospitalization cost[(46681.33±2260.17)RMB vs.(44899.14±3324.70)RMB,P<0.05]and medicine proportion[(25.09%±4.05%)vs.(22.36%±4.46%),P<0.01],with statistical difference(P<0.05)compared with the drainage group.Conclusions:Laparoscopic radical gastrectomy without abdominal drainage for distal gastric cancer is a safe,feasible and cost-effective enhanced recovery treatment strategy.