ERAS下腹腔镜辅助右半结肠癌扩大根治术的临床研究

Clinical study of ERAS laparoscopic assisted enlarged radical resection of right colon carcinoma

目的探讨加速康复外科(ERAS)应用于腹腔镜右半结肠癌扩大根治术患者的临床疗效。方法选取2017年1月至2019年12月行腹腔镜辅助右半结肠癌扩大根治术的进展期右半结肠癌患者50例,随机数字法将患者分为ERAS组和传统组,各25例。在围术期分别给予ERAS和传统处理措施,使用统计学软件SPSS 24.0进行临床数据分析,围术期指标等计量资料采用(±s)表示,组间采用独立t检验;术后并发症等计数资料采用χ^(2)检验;以P<0.05为检验标准。结果ERAS组术后首次排气时间、首次排便时间、下床活动时间及住院时间均较传统组更短;ERAS组并发症总发生率低于传统组,分别为12.0%及36.0%,以上两组间差异均有统计学意义(P<0.05)。两组患者术前1 d的白细胞、Cor、CRP及IL-6指标比较无明显差异(P>0.05),术后3 d ERAS组患者上述4项指标均明显小于传统组(P<0.05)。两组患者入院时血清白蛋白及前白蛋白水平比较差异无统计学意义(P>0.05)。术前1 d及术后3 d,ERAS组患者血清白蛋白及前白蛋白水平均明显高于对照组患者(P<0.05)。结论围术期应用ERAS理念于腹腔镜辅助右半结肠癌扩大根治术患者安全可行且有效,可减少患者应激反应,降低术后并发症发生率,加速患者术后早期康复。

Objective To observe the clinical effect of accelerated rehabilitation surgery(ERAS)laparoscopic enlarged radical resection of right colon cancer.Methods From January 2017 to December 2019,a total of 50 patients with advanced right colon cancer who underwent laparoscopic assisted enlarged radical resection of right colon cancer were randomly divided into ERAS group and traditional group,with 25 patients in each group.The patients were given ERAS measures and traditional treatment measures respectively during the perioperative period.SPSS 24.0 was used for clinical data analysis,Measurement data such as perioperative indicators were represented by,the results were compared with t test,the statistical data of postoperative complications were tested byχ^(2) test.P<0.05 was considered statistically significant.Result The first postoperative exhaust time,first defecation time,time of getting out-of-bed time and hospitalization time in ERAS group were shorter than those in the traditional group(12%and 36.0%,respectively),and the difference above between the two groups were statistically significant(P<0.05).There were no significant difference in WBC,COR,CRP and IL-6 between the two groups one day before surgery(P>0.05),and the above 4 indexes in ERAS group were significantly lower than those in the traditional group(P<0.05).There was no significant difference in serum albumin and prealbumin levels between the two groups at admission(P>0.05).The levels of serum albumin and prealbumin in ERAS group were significantly higher than those in control group 1 day before operation and 3 days after operation(P<0.05).Conclusion ERAS is safety、feasible and effective in perioperative period for patients undergoing laparoscopic-assisted radical resection of right colon cancer,which can reduce the stress response of patients,reduce the incidence of postoperative complications and accelerate the early postoperative recovery of patients.