加速康复外科在老年腹腔镜胃癌根治术中的应用价值研究

Application of enhanced recovery after surgery in perioperative period of laparoscopic radical gastrectomy for elderly patients

目的探讨加速康复外科(ERAS)在老年腹腔镜胃癌根治术围手术期应用的价值,以期为临床诊疗提供参考。方法选择2017年12月至2018年12月在蚌埠医学院第一附属医院胃肠外科接受诊疗的老年腹腔镜胃癌根治术患者96例,根据围手术期处理方法,将患者分为观察组(ERAS处理)和对照组(传统处理),各48例,对比两组患者临床基线资料、术中情况以及术后恢复情况、疼痛评分、并发症、住院情况。结果两组患者的临床基线资料、术中一般情况、术后并发症比较差异无统计学意义。与对照组相比,ERAS组患者术后首次进水时间、首次下床时间、肛门排气时间、尿管拔除时间、进流质时间、引流管拔除时间更早,术后6 h、1 d、3 d、5 d时VAS评分更低,术后住院时间和住院费用更低,差异均有统计学意义(P<0.05)。结论ERAS理念应用于老年腹腔镜胃癌根治术围手术期中安全有效,在不增加术后并发症的前提下能够促进患者术后康复,缩短住院时间,减少住院费用,具有临床推广应用价值。

Objective To explore the value of enhanced recovery after surgery(ERAS)in perioperative application of laparoscopic radical gastrectomy for elderly patients,so as to provide reference for clinical diagnosis and treatment.Methods A total of 96 patients undergoing laparoscopic radical gastrectomy in the First Affiliated Hospital of Bengbu Medical College from December 2017 to December 2018 were enrolled.According to the perioperative treatment method,the patients were divided into observation group(ERAS treatment)and the control group(traditional treatment),48 cases in each group.The general condition,intraoperative condition,and postoperative recovery,pain score,complications,inflammatory index,hospitalization were compared between the two groups.Results There were no significant differences in the general clinical data,intraoperative condition,postoperative complications between the two groups.Compared to the control group,the postoperative recovery of patients in the ERAS group including the time of first drinking,the first time to get out of bed,anal exhaust time,urinary catheter removal time,fluid intake time,and drainage tube removal time were significantly lower(P<0.05).The VAS scores of the patients in the ERAS group were significantly lower at 6 h,1 d,3 d and 5 d after operation(P<0.05).Postoperative hospital stay and postoperative hospitalization costs were significantly lower(P<0.05).Conclusions The ERAS concept is safe and effective in the elderly patients undergoing laparoscopic radical gastrectomy.It can promote postoperative rehabilitation,shorten patient stay,and reduce hospitalization costs without increasing postoperative complications.ERAS has a certain clinical promotion and application value.