ERAS模式在Ivor-Lewis联合空肠造瘘术在下段食管癌中应用的临床观察

Clinical observation of ERAS model in lower esophageal carcinoma treated with Ivor-Lewis combined jejunostomy

目的 分析ERAS模式在Ivor-Lewis联合空肠造瘘术治疗中下段食管癌效果。方法 选取我院2015年12月至2021年10月收治的117例中下段食管癌患者的临床资料。患者均接受Ivor-Lewis联合空肠造瘘术治疗。随机数字表法分为常规组(n=58,常规模式)与ERAS组(n=59,ERAS模式)。比较两组术中与术后指标、应激指标、生活质量及并发症。结果 ERAS组胃肠功能恢复时间、住院时间、引流管留置时间及肛门排气时间均短于常规组,术中出血量少于常规组(P<0.05)。术后,两组应激指标CRP、TNF-α及IL-6水平均较术前增高,ERAS组应激指标水平均低于常规组(P<0.05)。术后,两组EORTCQLQ-C30量表躯体、情绪、角色、认知、社会功能及总体健康评分均较术前增高,且ERAS组上述评分均高于常规组(P<0.05)。ERAS组并发症总发生率为15.25%,常规组并发症总发生率为20.69%,组间差异无统计学意义(P>0.05)。结论 在空肠造瘘术联合Ivor-Lewis术治疗中下段食管癌中采用ERAS模式可改善患者生活质量,减轻其应激反应,促进患者康复。

Objective To analyze the effect of ERAS model in the treatment of middle and lower esophageal carcinoma by Ivor-Lewis combined jejunostomy. Methods The clinical data of 117 patients with middle and lower esophageal cancer admitted to our hospital from December 2015 to October 2021 were selected. All patients received Ivor-Lewis combined jejunostomy. Random number table method was divided into conventional group(n=58, conventional mode) and ERAS group(n=59, ERAS mode). Intraoperative and postoperative indexes, stress indexes, quality of life and complications were compared between the two groups. Results The recovery time of gastrointestinal function, hospital stay, drainage indwelling time and anal exhaust time in ERAS group were shorter than those in conventional group, and the intraoperative blood loss was less than that in conventional group(P<0.05). After surgery, the levels of stress indexes CRP, TNF-α and IL-6 in both groups were higher than those before surgery, while the levels of stress indexes in ERAS group were lower than those in conventional group(P<0.05). After surgery, the EORTCQLQ-C30 physical, emotional, role, cognitive, social function and overall health scores in both groups were higher than those before surgery, and those scores in ERAS group were higher than those in conventional group(P<0.05). The total incidence of complications was 15.25% in ERAS group and 20.69% in conventional group, with no statistically significant difference between groups(P>0.05). Conclusion ERAS model can improve the quality of life, reduce stress response and promote recovery in patients with middle and lower esophageal cancer treated with jejunostomy combined with Ivor-Lewis.