加速康复外科理念在食管癌患者围术期的应用
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摘要
目的探讨加速康复外科理念在食管癌患者围术期中的应用。方法选取2014年5月至2016年5月间新疆医科大学附属肿瘤医院收治的270例接受手术治疗的食管癌患者,采用随机数字表法分为观察组和对照组,每组135例,观察组应用加速康复外科理念,对照组仅给予常规干预,对比两组患者围术期指标、并发症发生率和术后生存质量。结果对照组患者术后肠蠕动恢复时间、术后下床活动时间、术后静脉输液时间、术后住院时间、切口愈合时间和平均住院费用分别为(4.56±2.12)d、(4.23±1.59)d、(7.56±3.77)d、(11.36±4.21)d、(7.89±0.79)d和(3.58±1.54)万元,观察组患者术后肠蠕动恢复时间、术后下床活动时间、术后静脉输液时间、术后住院时间、切口愈合时间和平均住院费用分别为(3.02±1.15)d、(2.36±1.08)d、(4.89±2.46)d、(7.99±4.16)d、(6.13±0.55)d和(2.65±1.08)万元,两组组间比较,观察组患者术后肠蠕动恢复时间、术后下床活动时间、术后静脉输液时间、术后住院时间和切口愈合时间均较短,平均住院费用较少,差异均有统计学意义(均P<0.05)。对照组患者吻合口瘘、胸腔出血、腹胀和肺部感染的发生率分别为6.7%、6.7%、11.1%和8.9%,观察组患者吻合口瘘、胸腔出血、腹胀和肺部感染的发生率分别为2.2%、2.2%、4.4%和2.2%,两组组间比较,观察组患者吻合口瘘、胸腔出血、腹胀和肺部感染的发生率均较低,差异均有统计学意义(均P<0.05)。对照组患者社会活动、身体机能、精神心理和生活能力评分分别为(54.12±6.78)分、(64.12±6.35)分、(61.78±7.22)分和(65.25±7.25)分,观察组患者社会活动、身体机能、精神心理和生活能力评分分别为(68.96±7.56)分、(72.44±7.52)分、(73.26±7.56)分和(77.52±8.12)分,两组组间比较,观察组患者社会活动、身体机能、精神心理和生活能力评分均较高,差异均有统计学意义(均P<0.05)。结论对手术治疗的食管癌患者应用加速康复外科理念,可改善围术期指标,降低并发症发生率,改善预后,提高生存质量。
Objective To explore application of the concept of " fast track surgery" in perioperative esophageal cancer patients. Methods From May 2014 to May 2016,270 patients who underwent surgical treatment for esophageal cancer at Affiliated Tumor Hospital of Xinjiang Medical University were selected.Using random number table method,patients were divided into an observation group and a control group with135 patients in each group. The observation group was given care based on the concept of fast track surgery and the control group was only given regular intervention. Perioperative indicators,incidence of complications and postoperative quality of life were compared between the two groups. Results Postoperative bowel recovery time,postoperative ambulation time,intravenous infusion time,hospitalization time and wound healing time and the average hospitalization cost was( 3. 02 ± 1. 15) d、( 2. 36 ± 1. 08) d、( 4. 89 ± 2. 46) d、( 7. 99 ± 4. 16) d、( 6. 13 ± 0. 55) d、( 2. 65 ± 1. 08) thousand Yuan respectively for the observation group and( 4. 56 ± 2. 12) d、( 4. 23 ± 1. 59) d、( 7. 56 ± 3. 77) d、( 11. 36 ± 4. 21) d、( 7. 89 ± 0. 79) d、( 3. 58 ±1. 54) thousand Yuan for the control group. Postoperative intestinal peristalsis recovery time,ambulation time,intravenous infusion time,hospitalization time and incision healing time was shorter and the average hospitalization cost was less in the observation group compared with the control group( all P < 0. 05). The incidence of anastomotic fistula,hemorrhage of pleural cavity,abdominal distension and pulmonary infection was 2. 2%,2. 2%,4. 4% and 2. 2% respectively for the observation group which was lower than 6. 7%,6. 7%,11. 1% and 8. 9% of the control group respectively( all P < 0. 05). Scores of social activities,physical function,psychology and quality of life were( 68. 96 ± 7. 56) points,( 72. 44 ± 7. 52) points,( 73. 26 ± 7. 56) points,( 77. 52 ± 8. 12) points respectively for the observation group which were higher than( 54. 12 ± 6. 78) points,( 64. 12 ± 6. 35) points,( 61. 78 ± 7. 22) points,( 65. 25 ± 7. 25) points of the control group respectively( all P < 0. 05). Conclusion For esophageal cancer patients undergoing surgical treatment,concept of fast track surgery improves perioperative indicators,reduces the incidence of complications and improves prognosis and the quality of survival.
Objective To explore application of the concept of " fast track surgery" in perioperative esophageal cancer patients. Methods From May 2014 to May 2016,270 patients who underwent surgical treatment for esophageal cancer at Affiliated Tumor Hospital of Xinjiang Medical University were selected.Using random number table method,patients were divided into an observation group and a control group with135 patients in each group. The observation group was given care based on the concept of fast track surgery and the control group was only given regular intervention. Perioperative indicators,incidence of complications and postoperative quality of life were compared between the two groups. Results Postoperative bowel recovery time,postoperative ambulation time,intravenous infusion time,hospitalization time and wound healing time and the average hospitalization cost was( 3. 02 ± 1. 15) d、( 2. 36 ± 1. 08) d、( 4. 89 ± 2. 46) d、( 7. 99 ± 4. 16) d、( 6. 13 ± 0. 55) d、( 2. 65 ± 1. 08) thousand Yuan respectively for the observation group and( 4. 56 ± 2. 12) d、( 4. 23 ± 1. 59) d、( 7. 56 ± 3. 77) d、( 11. 36 ± 4. 21) d、( 7. 89 ± 0. 79) d、( 3. 58 ±1. 54) thousand Yuan for the control group. Postoperative intestinal peristalsis recovery time,ambulation time,intravenous infusion time,hospitalization time and incision healing time was shorter and the average hospitalization cost was less in the observation group compared with the control group( all P < 0. 05). The incidence of anastomotic fistula,hemorrhage of pleural cavity,abdominal distension and pulmonary infection was 2. 2%,2. 2%,4. 4% and 2. 2% respectively for the observation group which was lower than 6. 7%,6. 7%,11. 1% and 8. 9% of the control group respectively( all P < 0. 05). Scores of social activities,physical function,psychology and quality of life were( 68. 96 ± 7. 56) points,( 72. 44 ± 7. 52) points,( 73. 26 ± 7. 56) points,( 77. 52 ± 8. 12) points respectively for the observation group which were higher than( 54. 12 ± 6. 78) points,( 64. 12 ± 6. 35) points,( 61. 78 ± 7. 22) points,( 65. 25 ± 7. 25) points of the control group respectively( all P < 0. 05). Conclusion For esophageal cancer patients undergoing surgical treatment,concept of fast track surgery improves perioperative indicators,reduces the incidence of complications and improves prognosis and the quality of survival.
引文
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[9]廖信芳,李柱,杨清水,等.快速康复外科对腹腔镜辅助远端胃癌根治术的应激影响[J].南昌大学学报(医学版),2016,56:49-52.
[10]李向成,陈涛,廉彧.经右胸系膜切除食管癌的临床观察[J].中国肿瘤临床与康复,2014,21:97-98.
[11]苏红彬,金荣生,范圣雅,等.快速康复外科与腹腔镜技术对围手术期胃癌患者的影响[J].华南国防医学杂志,2012,26:237-240.
[12]陈保富,孔敏,朱成楚,等.胸腹腔镜下食管癌手术对患者术后早期肺功能的影响[J].中华外科杂志,2012,50:633-636.
[13]何荣琦,张万飞,庄建良,等.纵隔引流管对食管癌术后吻合口瘘、心肺并发症的临床意义[J].临床和实验医学杂志,2012,11:1866-1868.
[14]尤振兵,徐达夫,嵇建,等.快速康复外科理念在食管癌治疗中的应用[J].中华胃肠外科杂志,2012,15:561-563.
[2]王琪,吴明,沈钢,等.快速康复外科在微创食管癌切除术中的应用[J].中华胸心血管外科杂志,2013,29:349-353.
[3]田明发.胸腹腔镜联合治疗与食管癌根治术治疗食管癌的疗效观察[J].国际医药卫生导报,2012,18:1268-1270.
[4]李志龙,王一心,臧建洲.不同食管癌根治术对患者术后肺功能及炎性因子水平的影响[J].检验医学与临床,2016,13:746-748.
[5]刘宝兴,李印,秦建军,等.微创Mc Keown术与左胸径路食管切除术治疗胸中下段食管癌的比较[J].中华胸心血管外科杂志,2013,29:342-345.
[6]高萌,刘然,李青霞,等.加速康复外科护理在结肠癌腹腔镜手术中的应用[J].齐鲁医学杂志,2012,27:273-274.
[7]王强.快速康复外科在食管癌围术期的应用[J].中国老年学,2013,33:3423-3425.
[8]林小芳,黄先玲,钟番番,等.快速康复外科理念在食管癌患者围术期中的应用[J].齐鲁护理杂志,2014,20:43-44.
[9]廖信芳,李柱,杨清水,等.快速康复外科对腹腔镜辅助远端胃癌根治术的应激影响[J].南昌大学学报(医学版),2016,56:49-52.
[10]李向成,陈涛,廉彧.经右胸系膜切除食管癌的临床观察[J].中国肿瘤临床与康复,2014,21:97-98.
[11]苏红彬,金荣生,范圣雅,等.快速康复外科与腹腔镜技术对围手术期胃癌患者的影响[J].华南国防医学杂志,2012,26:237-240.
[12]陈保富,孔敏,朱成楚,等.胸腹腔镜下食管癌手术对患者术后早期肺功能的影响[J].中华外科杂志,2012,50:633-636.
[13]何荣琦,张万飞,庄建良,等.纵隔引流管对食管癌术后吻合口瘘、心肺并发症的临床意义[J].临床和实验医学杂志,2012,11:1866-1868.
[14]尤振兵,徐达夫,嵇建,等.快速康复外科理念在食管癌治疗中的应用[J].中华胃肠外科杂志,2012,15:561-563.