快速康复外科干预对老年食管癌患者术后康复效果、营养状况及预后的影响

Effect of fast track surgery intervention on postoperative rehabilitation,nutritional status and prognosis of elderly patients with esophageal cancer

目的分析快速康复外科(fast track surgery,FTS)干预对老年食管癌患者术后康复效果、营养状况及预后的影响。方法选取2013年9月至2015年6月于吉林大学第一医院就诊的97例老年食管癌患者为研究对象。按照随机数字表法将其分为观察组(48例)和对照组(49例),观察组患者围术期接受FTS干预,对照组患者围术期接受传统干预。观察并比较两组患者术后康复效果、营养状况和预后。结果观察组患者胸腔引流管留置时间、术后进食时间、住院天数均显著短于对照组(均P<0.05),并发症总发生率显著低于对照组(P<0.05)。两组患者术后1 d血红蛋白、前白蛋白、白蛋白和转铁蛋白水平均显著低于本组术前(均P<0.05),术后5 d上述指标水平均略有回升(均P<0.05)。两组患者术后1 d和5 d前白蛋白、白蛋白和转铁蛋白水平比较差异均有统计学意义(均P<0.05),但两组患者术后1 d和5 d血红蛋白水平比较差异均无统计学意义(均P>0.05)。术后所有患者均获得随访,两组患者平均生存时间和3年生存率比较差异均无统计学意义(均P>0.05)。观察组患者1年和5年生存率均显著高于对照组(均P<0.05)。结论老年食管癌患者围术期采用FTS干预,可有效提高康复效果,改善患者营养状况和预后。

Objective To analyze the effect of fast track surgery(FTS)intervention on postoperative rehabilitation,nutritional status and prognosis of elderly patients with esophageal cancer.Method Ninety-seven elderly patients with esophageal cancer who were treated in the First Hospital of Jilin University from September 2013 to June 2015 were selected as the research objects.Patients were randomly divided into observation group(48 cases)and control group(49 cases)according to the random number table method.Patients in observation group received FTS intervention during the perioperative period,and patients in control group received traditional intervention during the perioperative period.The differences of postoperative rehabilitation effects,nutritional status and prognosis between the two groups were observed and compared.Result The indwelling time of thoracic drainage tube,postoperative feeding time and hospital day in observation group were significantly shorter than those in control group(all P<0.05),and the total incidence of complications was significantly lower than that in control group(P<0.05).One day after surgery,the levels of hemoglobin,prealbumin,albumin and transferrin in the two groups were significantly lower than those before surgery(all P<0.05);five days after surgery,the above-mentioned indexes all rose slightly(all P<0.05).There were significant differences in the levels of prealbumin,albumin and transferrin between the two groups on one day and fives days after surgery(all P<0.05).However,there were no significant differences in hemoglobin levels between the two groups on one day and five days after surgery(all P>0.05).All patients were followed up after surgery.There were no significant differences in the average survival time and three-year survival rate between the two groups(all P>0.05).The one-year and five-year survival rates of patients in observation group were significantly higher than those in control group(all P<0.05).Conclusion Perioperative intervention with FTS in elderly patients with esophageal cancer can effectively improve the rehabilitation effect,nutritional status and prognosis.