ERAS用于进展期胃癌D2根治术对胃肠功能恢复情况及生存质量的影响

Impact of ERAS concepton the recovery of gastrointestinal function and quality of life of patients with advanced gastric cancer after laparoscopic D2 radical surgery

目的探讨快速康复外科(ERAS)理念用于进展期胃癌D2根治术对胃肠功能恢复情况及生存质量的影响。方法回顾性分析96例进展期胃癌患者,分为ERAS组和常规组,各48例,两组患者均行腹腔镜D2根治术,常规组给予常规围术期处理措施,ERAS组给予ERAS理念。数据处理应用统计学软件SPSS 22.0完成。术中术后指标、手术前后QOL评分数据用■表示,采用独立t检验;并发症发生率及复发率组间比较采用四格表χ~2检验;P<0.05为差异存在统计学意义。结果 ERAS组患者首次排气时间、下床活动时间、胃管拔出时间、首次排便时间、住院时间均较常规组短(均P<0.05)。ERAS组并发症发生率为8.3%(4/48)明显低于常规组22.9%(11/48)(P<0.05)。ERAS组术后1年复发率为6.3%(3/48),常规组为20.8%(10/48),ERAS组低于常规组(P<0.05)。术前两组患者QOL评分的差异无统计学意义(P>0.05)。两组患者术后3个月、术后6个月QOL评分均高于术前(均P<0.05);ERAS组患者高于常规组(均P<0.05)。结论 ERAS理念用于进展期胃癌D2根治术中的效果良好,可缩短胃肠道功能恢复时间,降低术后并发症及复发率,并提高患者的生存质量,安全性较高,值得推广应用。

Objective To investigate the impact of enhanced recovery after surgery(ERAS)concept on the recovery of gastrointestinal function and quality of life of patients with advanced gastric cancer after D2 radical surgery. Methods Clinical data of 96 patients with advanced gastric cancer were analyzed retrospectively, of whom were randomly divided into ERAS group(n=48) and control group(n=48). Patients in both groups underwent laparoscopic D2 radical surgery. SPSS21.0 softwarewas used for data analysis. Measurement data such as gastrointestinal function recovery and quality of life scores were examined by using independent t test. Complication rate and recurrence rate were compared with χ~2 test. P<0.05 was considered as significant difference. Results The first exhaust time, the time of ambulation, the time of gastric tube extraction, the time of first defecation, and hospitalization time in the ERAS group were significantlyshorter than those in control group respectively(P<0.05). The complication rate of the ERAS group of 8.3%(4/48)was significantly lower than 22.9%(11/48) in control group(P<0.05). The 1-year recurrence rate of 6.3%(3/48) in the ERAS group was significantly lower than20.8%(10/48) in the control group(P<0.05). There was no significant difference in QOL score between two groups before operation(P>0.05). The QOL scores of the two groups 3 months and 6 months after operation were higher than those before operation(P<0.05). The QOL scores of the ERAS group were higher than those of the regular group at 3 months and 6 months after operation(P<0.05). Conclusion The ERAS concept is effective in the treatment of patients with advanced gastric cancer after laparoscopic D2 radical surgery,which could not only shorten the recovery time of gastrointestinal function,but also reduce postoperative complications,recurrence rate and improve the quality of life of patients with high safety. It is worthy of popularization and application.