快速康复外科在低位直肠癌术后保护性回肠造口还纳中的效果
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摘要
目的探讨快速康复外科在低位直肠癌术后保护性回肠造口还纳中的效果。方法回顾性选取2015年1月至2018年1月上海市杨浦区市东医院外二科收治的低位直肠癌前切除术后行保护性回肠造口还纳术的患者共54例,按照围手术期处理方法将54例患者分为研究组和对照组,每组各27例。其中研究组(n=27)采用快速康复外科理念进行围手术期处理,对照组(n=27)按常规措施进行围手术期处理。观察并比较两组患者术前及术后第3天的血清白蛋白、前白蛋白和C反应蛋白(CRP)的水平,以及患者的手术时间、术中出血量、术后首次肛门排气时间、排便时间、口服或肠内营养时间、术后住院时间、主要并发症等。结果两组患者术前血清白蛋白、前白蛋白、CRP水平差异无统计学意义,术后第3天研究组血清白蛋白、前白蛋白水平显著高于对照组,CRP水平显著低于对照组(P <0. 05)。两组患者手术时间和术中出血量差异无统计学意义(P> 0. 05)。研究组患者术后首次肛门排气时间、排便时间和口服或肠内营养时间均早于对照组,术后住院时间低于对照组,差异具有统计学意义(P <0. 05)。研究组总并发症发生率(25. 93%,7/27)显著低于对照组(14. 81%,4/27),差异有显著性(χ2=4. 063,P=0. 0438)。结论围手术期采用快速康复外科措施,可以缩短低位直肠癌术后保护性回肠造口还纳患者的住院治疗时间,减轻患者的应激反应,促进患者早期康复。
Objective To explore the effect of rapid rehabilitation surgery on protective ileostomy after low rectal cancer operation. Methods 54 patients with protective ileostomy after anterior resection of low rectal cancer in the Department of 2 nd General Surgery of this hospital during January 2015 to January 2018 were selected. All these 54 patients were divided into study group and control group by random number table method,27 cases in each group. Patients in study group( n = 27) were applied with the concept of rapid rehabilitation surgery for perioperative management,and patients in control group( n = 27) underwent perioperative management according to routine measures. The serum levels of albumin,prealbumin and C reactive protein in patients of these two groups were observed and compared before and in the third day after operation. The level of C-reactive protein( CRP) was compared,as well as the patient's operating time,amount of intraoperative blood loss,first postoperative anal exhaust,defecation time,time for oral or enteral nutrition supply,postoperative hospital stay,major complications,etc. Results There was no significant difference before operation in serum levels of albumin,prealbumin,and CRP between these two groups. Serum levels of albumin and prealbumin were significantly higher in patients of study group than those of control group in 3 days after the operation. Blood levels of CRP were significantly lower than those of control group. There was no significant difference in operating time and amount of intraoperative blood loss between these two groups. The defication time and oral or enteral nutrition time in study group were earlier than those of control group,and the postoperative hospital stay was lower than that of control group. There was statistically significant difference in the incidence of total complications between these two groups 14. 81%( 4/27),25. 93%( 7/27),they were significantly lower in study group than those of control group( χ2= 4. 063,P = 0. 0438). Conclusion The application of rapid rehabilitation procedure in perioperative period can shorten the hospitalization time of patients with protective ileostomy and rectectomy for low rectal cancer,reduce the stress of patients and promote the early rehabilitation.
Objective To explore the effect of rapid rehabilitation surgery on protective ileostomy after low rectal cancer operation. Methods 54 patients with protective ileostomy after anterior resection of low rectal cancer in the Department of 2 nd General Surgery of this hospital during January 2015 to January 2018 were selected. All these 54 patients were divided into study group and control group by random number table method,27 cases in each group. Patients in study group( n = 27) were applied with the concept of rapid rehabilitation surgery for perioperative management,and patients in control group( n = 27) underwent perioperative management according to routine measures. The serum levels of albumin,prealbumin and C reactive protein in patients of these two groups were observed and compared before and in the third day after operation. The level of C-reactive protein( CRP) was compared,as well as the patient's operating time,amount of intraoperative blood loss,first postoperative anal exhaust,defecation time,time for oral or enteral nutrition supply,postoperative hospital stay,major complications,etc. Results There was no significant difference before operation in serum levels of albumin,prealbumin,and CRP between these two groups. Serum levels of albumin and prealbumin were significantly higher in patients of study group than those of control group in 3 days after the operation. Blood levels of CRP were significantly lower than those of control group. There was no significant difference in operating time and amount of intraoperative blood loss between these two groups. The defication time and oral or enteral nutrition time in study group were earlier than those of control group,and the postoperative hospital stay was lower than that of control group. There was statistically significant difference in the incidence of total complications between these two groups 14. 81%( 4/27),25. 93%( 7/27),they were significantly lower in study group than those of control group( χ2= 4. 063,P = 0. 0438). Conclusion The application of rapid rehabilitation procedure in perioperative period can shorten the hospitalization time of patients with protective ileostomy and rectectomy for low rectal cancer,reduce the stress of patients and promote the early rehabilitation.
引文
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[4]Forsmo HM,Erichsen C,Rasdal A,et al.Randomized Controlled Trial of Extended Perioperative Counseling in Enhanced Recovery After Colorectal Surgery[J].Dis Colon Rectum,2018,61(6):724-732.
[5]Ljungqvist O,Scott M,Fearon KC.Enhanced Recovery After Surgery:A Review[J].JAMA Surg,2017,152(3):292-298.
[6]Feng F,Li XH,Shi H,et al.Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients:a randomized controlled clinical trial[J].J Dig Dis,2014,15(6):306-313.
[7]张勤学.C反应蛋白等检测对肺炎合并全身炎症反应综合征诊断的价值研究[J].人民军医,2017,60(8):785-787.
[8]Zhao JH,Sun JX,Gao P,et al.Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery:a meta-analysis[J].BMC Cancer,2014,14:607.
[9]Naef M,Kasemodel GK,Mouton WG,et al.Outcome of colorectal cancer surgery in the early fast-track era with special regard to elderly patients[J].Int Surg,2010,95(2):153-159.