快速康复外科理念用于进展期胃癌D2根治术围术期的临床价值

Perioperative clinical value of rapid rehabilitation surgery for D2 radical resection of advanced gastric cancer

目的探究快速康复外科(ERAS)理念用于进展期胃癌D2根治术围手术期的临床价值。方法回顾性分析2018年5月至2020年5月我院收治的637例进展期胃癌患者病例资料,根据围手术期不同处理方式分为ERAS组(n=327例)和传统组(n=310例)。统计分析软件采用SPSS 22.0,术中和术后相关指标和应激指标以(x±s)表示,采用独立样本X^(2)检验;并发症等计数资料采用x检验。P<0.05为差异有统计学意义。结果ERAS组患者术后输液量、住院天数、首次通气时间、首次进食时间、胃管留置时间和引流管拔除时间均小于传统组(P<0.05);术后1d和3d,ERAS组患者血清C反应蛋白和白细胞水平少于传统组(P<0.05)。ERAS组患者术后并发症总发生率和术后1年复发率较传统组低(30.6%VS.48.4%,6.4%VS.20.9%),差异均有统计学意义(P<0.05)。结论ERAS理念用于进展期胃癌D2根治术可减少患者术后首次排气排便时间拔除弓|流管时间、进食时间等,有助于减轻机体炎症反应,降低术后并发症发生率。

Objective To investigate the perioperative value of of enhanced recovery after surgery(ERAS)in D2 radical gastrectomy for advanced gastric cancer.Methods A retrospective analysis was performed on the clinical data of 637 patients with gastric cancer from May 2018 to May 2020.According to different methods of perioperative management,they were divided into ERAS group(n=327 cases)and traditional group(n=310 cases).SPSS 22.0 was used for statistical analysis.The intraoperative and postoperative related indexes and stress indexes were tested by(x±s)and independent t test.X^(2) test was used for complications.P<O.05 was considered statistically significant.Results In ERAS group,postoperative fluid infusion,length of hospital stay,time of first ventilation,time of first feeding,time of gastric tube indwelling and time of drainage tube removal were all shorter than those in traditional group(P<O.05).The levels of C-reactive protein and white blood cells in the ERAS group were lower than those in the traditional group 1 and 3 days after operation,and the differences were statistically significant(P<O.05).The total incidence of postoperative complications and 1 year recurrence rate in ERAS group were lower than those in traditional group(30.6%VS.48.4%,6.4%VS.20.9%),with statistical significance(P<O.05).Conclusion The application of ERAS in D2 radical gastrectomy for advanced gastric cancer can reduce the time of initial postoperative defecation,drainage tube removal,feeding,etc.,which can help reduce the inflammatory response of the body and reduce the incidence of postoperative complications.