加速康复外科在胃癌合并肝硬化病人中的临床应用

The clinical efficacy of enhanced recovery after surgery combining with laparoscopy operation in gastric cancer and liver cirrhosis patients

目的 探讨加速康复外科(enhanced recovery after surgery, ERAS)在胃癌合并肝硬化病人围手术期处理中的应用其价值。方法 2016年1月~2020年12月我院确诊为胃癌合并肝硬化的病人46例,将46例病人分为两组,对照组23例,按照传统方法进行围手术期管理,加速康复组(ERAS组)23例,采用ERAS理念进行围手术期管理。比较两组病人术前及术后第1天、3天、7天的丙氨酸氨基转移酶、门冬氨酸氨基转移酶、凝血指标D-二聚体、白细胞、C反应蛋白、白细胞介素-6水平,记录两组病人手术持续时间、术中出血量、术后疼痛评分、首次排气时间、下床活动时间、住院时间以及手术并发症发生率。结果 ERAS组术后第1天、3天、7天的白细胞、C反应蛋白、白细胞介素-6、D-二聚体及术后疼痛评分明显低于对照组,差异有统计学意义(P<0.05)。术后排气时间、下床活动时间、出院时间均早于对照组,差异有统计学意义(P<0.05),术后谷丙氨酸氨基转移酶、门冬氨酸氨基转移酶、并发症发生率比较,差异无统计学意义(P>0.05)。结论 ERAS理念能够减轻胃癌合并肝硬化病人围手术期的创伤及应激反应、缩短住院时间,不增加并发症发生率。

Objective To investigate the clinical efficacy of enhanced recovery after surgery(ERAS) combining with laparoscopy operation in gastric cancer and liver cirrhosis patients.Methods From January in 2016 to December in 2020,46 patients of gastric cancer and liver cirrhosis were analyzed retrospectively, and divided into the conrtol group of 23 cases, perioperative management according to traditional methods, 23 cases of accelerated recovery group(ERAS group),perioperative management with ERAS in Jingzhou central hospital.AST,ALT,d dimmers, White blood cell(WBC) count, C reaction protein(CRP) and IL-6 in the 46 patients were assayed preoperatively and at day 1,3,7 postoperatively.The operation time, intraoperative blood loss, pain scores, time to flatus, time to get out of bed, duration of hospital stay and postoperative complications were recorded and compared respectively.Results The leukocyte, C-reactive protein, interleukin-6,D-dimer and postoperative pain scores of ERAS group were significantly lower than those of control group at 1,3 and 7 days after surgery, and the differences were statistically significant(P<0.05).The postoperative exhaust time, ambulation time and discharge time were all earlier than those of the control group, and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative alanine aminotransferase, aspartate aminotransferase and complications(P>0.05).Conclusion ERAS can decrease postoperative stress level, shorten the duration of hospital stay and postoperative complication for gastric cancer and liver cirrhosis.It is safe and feasible for the perioperative treatment of patients with gastric cancer and liver cirrhosis.