ERAS理念应用于经肛门内镜微创手术患者的初步探讨

Enhanced recovery after surgery in patients undergoing transanal endoscopic mi⁃crosurgery:a primary analysis

目的探讨ERAS理念应用于经肛门内镜微创手术(TEM)患者围手术期的临床效果。方法选取2016年1月至2019年9月徐州医科大学附属淮安医院普外科收治的60例接受TEM治疗的直肠肿瘤患者为研究对象。采用随机数字表法分为ERAS组及传统组,每组各30例,传统组采用传统围手术期治疗方案,ERAS组在传统组基础上融合ERAS理念予以干预。比较两组术后相关指标、肛管直肠压力(ARP、MSP)、术后并发症、不适症状、血清应激水平指标及血清免疫功能指标。结果 ERAS组术后住院时间、首次排气时间、首次排便时间、下地活动时间及进食半流质饮食时间均较传统组提前(均P<0.05)。两组术前ARP、MSP比较差异无统计学意义(均P>0.05);两组术后1个月ARP、MSP较术前均下降(均P<0.05)。ERAS组术后5个月ARP恢复至术前水平,术后3个月MSP恢复至术前水平;传统组术后6个月ARP恢复至术前水平,术后3个月MSP恢复至术前水平。ERAS组术后1、3、5个月ARP高于传统组(均P<0.05),术后1、2个月时MSP高于传统组(均P<0.05)。两组在术后并发症总发生率比较差异无统计学意义(P>0.05)。ERAS组肛周不适和腹胀症状发生率低于传统组(均P<0.05),两组术后发热和恶心呕吐发生率比较差异均无统计学意义(均P>0.05)。两组术前CRP、IL-6、IgA、IgG、IgM组间比较差异均无统计学意义(均P>0.05);两组术后CRP、IL-6高于术前,IgA、IgG、IgM低于术前(均P<0.05);ERAS组术后CRP、IL-6水平低于传统组,IgA、IgG、IgM高于传统组(均P<0.05)。结论对接受TEM治疗的直肠肿瘤患者采用ERAS理念优化围手术期干预,可进一步促进患者康复,减轻患者围手术期应激反应及其对机体免疫功能的影响。

Objectives To investigate the effect of enhanced recovery after surgery(ERAS)in patients undergoing transanal en⁃doscopic microsurgery(TEM).Methods Sixty patients with rectal tumor undergoing TEM at the Department of Gastrointestinal Surgery,the Affiliated Huai’an Hospital of Xuzhou Medical University,between January 2016 and September 2019 were recruit⁃ed.Patients were randomly assigned to the ERAS group(ERAS with conventional perioperative treatment)and conventional group(conventional perioperative treatment),with 30 cases in each group.Surgical parameters,anorectal pressure(ARP,MSP),postopera⁃tive complications,postoperative discomfort symptoms,and serum levels of stress and immune function indicators were compared between the two groups.Results The postoperative hospitalization and the time to first flatus,the time to first bowel movement,out of bed activity,and semi-fluid diet were significantly shorter in the ERAS group than in the conventional group(P<0.05).Both ARP and MSP did not differ between the two group before surgery(P>0.05).ARP and MSP decreased in both groups at 1 month after surgery(P<0.05).In ERAS group,ARP returned to preoperative level at 5 months and MSP returned to preoperative level at 3 months after surgery.The corresponding time points in the conventional group were at 6 months and 3 months,respec⁃tively.ARP at 1,3,and 5 months after surgery and MSP at 1 and 2 months after surgery were significantly higher in the ERAS group than in the conventional group(P<0.05).The overall incidence of complications was comparable between the two groups(P>0.05).The incidence of anal discomfort and bloating was significantly lower in the ERAS group(P<0.05),and the inci⁃dence of postoperative fever,nausea&vomiting did not differ between the two groups(P>0.05).Preoperative levels of CRP,IL-6,IgA,IgG,and IgM were similar between the two groups(P>0.05).In both groups,the levels of CRP and IL-6 increased,while IgA,IgG,and IgM decreased after surgery(P<0.05).The levels of CRP and IL-6 after surgery were significantly lower,and the levels of IgA,IgG,and IgM significantly were higher in the ERAS group than in the conventional group(P<0.05).Conclusion In patients with rectal tumor undergoing TEM,ERAS could promote patients’recovery and reduce perioperative stress re⁃sponse and its impact on patients’immune function.