快速康复外科理念对腹腔镜结直肠癌经自然腔道标本取出手术患者术后恢复和并发症发生率的影响

Effect of enhanced recovery after surgery on postoperative recovery and complication rate of patients undergoing laparoscopic colorectal-carcinoma natural orifice specimen extraction surgery

目的探讨快速康复外科理念(ERAS)对腹腔镜结直肠癌经自然腔道标本取出手术(NOSES)患者术后恢复和并发症发生率的影响。方法抽取2019年9月至2021年9月濮阳市油田总医院收治的结直肠癌患者30例,其中采用常规护理进行腹腔镜结直肠癌根治术者15例为对照组,采取ERAS+NOSES者15例作为观察组。比较两组恢复情况、围术期情况、术后疼痛评分、C反应蛋白(CRP)检测水平、生活自理能力水平及并发症发生率。结果与对照组比较,观察组首次进食、首次排气、住院时间较短(P<0.05),术中出血量较少(P<0.05);术后第1、3、7天,与对照组比较,观察组术后疼痛评分较低(P<0.05);术后第1、2、3天,与对照组比较,观察组CRP水平较低(P<0.05);术后第1、3天,与对照组比较,观察组生活自理能力水平较高(P<0.05);观察组并发症发生率为13.33%(2/15),与对照组的(20.00%,3/15)比较,差异未见统计学意义(P>0.05)。结论ERAS应用于腹腔镜结直肠癌NOSES患者,有利于改善患者围术期情况,促进其术后恢复,缓解术后疼痛及炎症,提高生活自理能力,减少并发症发生率。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on postoperative recovery and incidence of complications in patients undergoing laparoscopic colorectal-carcinoma natural orifice specimen extraction surgery(NOSES).Methods Thirty patients with colorectal cancer treated in Puyang Oilfield General Hospital from September 2019 to September 2021 were selected.Among them,15 patients who underwent laparoscopic radical colorectal cancer surgery with routine care were selected as the control group,and 15 patients who underwent ERAS combined with NOSES were selected as the observation group.The recovery,perioperative situation,postoperative pain score,C-reactive protein(CRP)level,self-care ability and incidence of complications were compared between the two groups.Results Compared with the control group,the observation group had shorter first intake,first exhaust and hospital stay(P<0.05),and less intraoperative bleeding(P<0.05).On the 1st,3rd and 7th day after operation,compared with the control group,the postoperative pain score of the observation group was lower(P<0.05);on the 1st,3rd day after operation,the detection level of CRP was lower(P<0.05);on the 1st,2nd,3rd day after operation,the level of self-care ability in the observation group was higher than that in the control group(P<0.05).The incidence of complications in the observation group was 13.33%(2/15),which had no significant difference with the 20.00%(3/15)in the the control group(P>0.05).Conclusions ERAS can improve the perioperative condition of patients undergoing laparoscopic colorectal-carcinoma NOSES,promote their postoperative recovery,relieve postoperative pain and inflammation,improve the self-care ability and reduce the incidence of complications.