快速康复外科理念在新辅助化疗联合腹腔镜下胃癌D2根治术治疗进展期胃癌中的应用
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摘要
目的探讨在新辅助化疗联合腹腔镜下胃癌D2根治术治疗进展期胃癌中应用快速康复外科理念的可行性。方法进展期胃癌患者132例,随机分为观察组59例和对照组73例,2组新辅助化疗均采用FOLFOX6(奥沙利铂+亚叶酸钙+氟尿嘧啶)方案,化疗2~4个周期行超声内镜及腹部增强CT扫描,发现肿瘤进展时行腹腔镜下胃癌D2根治术。观察组围手术期给予快速康复外科理念指导,对照组给予常规处理。比较2组术后首次排气时间、排便时间、住院时间、手术时间、术中出血量、淋巴结清扫数目,及泌尿系统感染、肺部感染、下肢深静脉血栓形成、吻合口漏、伤口感染、腹盆腔脓肿、肠梗阻等并发症发生率。结果观察组52例完成4个周期化疗,7例完成2个周期化疗;对照组64例完成4个周期化疗,9例完成2个周期化疗;观察组手术时间[(300.15±26.87)min]、术中出血量[(249.08±18.47)mL]、淋巴结清扫数目[(19.97±3.79)枚]与对照组[(298.22±32.32)min、(250.16±16.26)mL、(19.96±3.62)枚]比较差异均无统计学意义(P>0.05);观察组术后首次排气时间[(60.10±5.94)h]、排便时间[(80.49±6.27)h]、住院时间[8(7,9)d]均较对照组[(90.03±5.02)h、(119.40±8.46)h、11(10,12)d]短(P<0.05),泌尿系统感染发生率(1.7%)低于对照组(12.3%)(P<0.05);观察组肺部感染、下肢深静脉血栓形成、吻合口漏、伤口感染、腹盆腔脓肿、肠梗阻发生率(3.4%、1.7%、0、1.7%、0、5.1%)与对照组(11.0%、4.1%、2.7%、2.7%、1.4%、4.1%)比较差异均无统计学意义(P>0.05)。结论进展期胃癌患者行新辅助化疗联合腹腔镜下胃癌D2根治术围术期应用快速康复外科理念可缩短康复时间,降低术后泌尿系统感染发生率。
Objective To explore the feasibility of fast-track surgery in neoadjuvant chemotherapy combined with laparoscopic D2 radical gastrectomy for advanced gastric cancer.Methods Totally 132 patients with advanced gastric cancer were randomly divided into observation group(n=59)and control group(n=73).Both two groups received FOLFOX6(oxaliplatin +folate calcium + fluorouracil)regimen.Endoscopic ultrasonography and abdominal enhanced CT examination were used after chemotherapy for 2 to 4 cycles,and laparoscopic D2 radical gastrectomy was performed as the cancer was found progressive.Observation group received the guidance of concept of fast-track surgery in the perioperative period,and control group was given routine treatment.The postoperative first exhaust time,defecation time,hospitalization stay,operation lasting time,intraoperative blood loss,the harvested lymph node count,and the incidences of the complications as urinary tract infection,pulmonary infection,deep venous thrombosis of the lower extremities,anastomotic leakage,wound infection,abdominal pelvic abscess and intestinal obstruction were compared between two groups.Results In observation group,52 patients completed 4 cycles of chemotherapy,and 7 patients completed 2 cycles.In control group,64 patients completed 4 cycles of chemotherapy and 9 patients completed 2 cycles.There were no significant differences in the operation lasting time((300.15±26.87)min vs(298.22±32.32)min),the intraoperative blood loss((249.08±18.47)mL vs(250.16±16.26)mL)and the harvested lymph node count(19.97±3.79 vs 19.96±3.62)between observation group and control group(P>0.05).The postoperative first exhaust time((60.10±5.94)h),defecation time((80.49±6.27)h)and hospitalization stay(8(7,9)d)in observation group were significantly shorter than those in control group((90.03±5.02)h,(119.40±8.46)h,11(10,12)d)in control group(P<0.05).The incidence of urinary tract infection was significantly lower in observation group(1.7%)than that in control group(12.3%)(P<0.05).There were no significant differences in the incidences of pulmonary infection,deep venous thrombosis of the lower extremities,anastomotic leakage,wound infection,abdominal pelvic abscess and intestinal obstruction between observation group(3.4%,1.7%,0,1.7%,0,5.1%)and control group(11.0%,4.1%,2.7%,2.7%,1.4%,4.1%)(P>0.05).Conclusion Fast-track surgery in neoadjuvant chemotherapy combined with laparoscopic D2 radical gastrectomy for advanced gastric cancer can shorten the recovery time and reduce the incidence of postoperative urinary tract infection.
Objective To explore the feasibility of fast-track surgery in neoadjuvant chemotherapy combined with laparoscopic D2 radical gastrectomy for advanced gastric cancer.Methods Totally 132 patients with advanced gastric cancer were randomly divided into observation group(n=59)and control group(n=73).Both two groups received FOLFOX6(oxaliplatin +folate calcium + fluorouracil)regimen.Endoscopic ultrasonography and abdominal enhanced CT examination were used after chemotherapy for 2 to 4 cycles,and laparoscopic D2 radical gastrectomy was performed as the cancer was found progressive.Observation group received the guidance of concept of fast-track surgery in the perioperative period,and control group was given routine treatment.The postoperative first exhaust time,defecation time,hospitalization stay,operation lasting time,intraoperative blood loss,the harvested lymph node count,and the incidences of the complications as urinary tract infection,pulmonary infection,deep venous thrombosis of the lower extremities,anastomotic leakage,wound infection,abdominal pelvic abscess and intestinal obstruction were compared between two groups.Results In observation group,52 patients completed 4 cycles of chemotherapy,and 7 patients completed 2 cycles.In control group,64 patients completed 4 cycles of chemotherapy and 9 patients completed 2 cycles.There were no significant differences in the operation lasting time((300.15±26.87)min vs(298.22±32.32)min),the intraoperative blood loss((249.08±18.47)mL vs(250.16±16.26)mL)and the harvested lymph node count(19.97±3.79 vs 19.96±3.62)between observation group and control group(P>0.05).The postoperative first exhaust time((60.10±5.94)h),defecation time((80.49±6.27)h)and hospitalization stay(8(7,9)d)in observation group were significantly shorter than those in control group((90.03±5.02)h,(119.40±8.46)h,11(10,12)d)in control group(P<0.05).The incidence of urinary tract infection was significantly lower in observation group(1.7%)than that in control group(12.3%)(P<0.05).There were no significant differences in the incidences of pulmonary infection,deep venous thrombosis of the lower extremities,anastomotic leakage,wound infection,abdominal pelvic abscess and intestinal obstruction between observation group(3.4%,1.7%,0,1.7%,0,5.1%)and control group(11.0%,4.1%,2.7%,2.7%,1.4%,4.1%)(P>0.05).Conclusion Fast-track surgery in neoadjuvant chemotherapy combined with laparoscopic D2 radical gastrectomy for advanced gastric cancer can shorten the recovery time and reduce the incidence of postoperative urinary tract infection.
引文
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[8]董峰,牛跃平,孙培春,等.腹腔镜辅助下与开腹胃癌根治术治疗进展期远端胃癌临床对照研究[J].中华实用诊断与治疗杂志,2013,27(5):457-459.
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[10]LI Z Y,KOH C E,BU Z D,et al.Nedadjuvant chemotherapy with FOLFOX:improved outcomes in Chinese patients with locally advanced gastric cancer[J].J Surg Oncol,2012,105(8):793-796.
[11]谭黄业,樊献军,马恒涛,等.快速康复外科理念在胰腺横断伤围手术期处理中的应用价值[J].中华实用诊断与治疗杂志,2014,28(11):1097-1098.
[12]吴庆邦.快速康复外科在胃癌手术中的应用效果[J].现代诊断与治疗,2014,25(13):3015-3016.
[13]吴斌,张光年,邓大炜,等.快速康复外科在大范围肝切除术围手术期中的应用[J].中华实用诊断与治疗杂志,2017,31(1):36-38.
[14]汪海,吴佩.快速康复外科在胃癌围手术期中的应用进展[J].牡丹江医学院学报,2015,36(6):96-99.
[15]张理想,徐阿曼,韩文秀,等.快速康复外科在胃癌中的应用[J].安徽医药,2017,21(5):948-951.
[2]NEWTON A D,DATTA J,LOAIZA-BONILLA A,et al.Neoadjuvant therapy for gastric cancer:current evidence and future directions[J].J Gastrointest Oncol,2015,6(5):534-543.
[3]余佩武,钱锋,郝迎学,等.腹腔镜胃癌根治术726例的疗效分析[J].中华消化外科杂志,2011,10(1):44-47.
[4]FENG F,JI G,LI J P,et al.Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients[J].World J Gastroenterol,2013,19(23):3642-3648.
[5]张永康,杨林.局部进展期胃癌的治疗进展[J].安徽医科大学学报,2013,48(8):992-994.
[6]吴留成,黄名威,覃宇,等.进展期胃癌新辅助化疗原发灶病理完全缓解5例报告及文献复习[J].中国肿瘤临床,2016,43(6):265-270.
[7]邹德芳.进展期胃癌行新辅助化疗对手术风险及预后的影响[J].现代消化及介入诊疗,2016,21(1):104-106.
[8]董峰,牛跃平,孙培春,等.腹腔镜辅助下与开腹胃癌根治术治疗进展期远端胃癌临床对照研究[J].中华实用诊断与治疗杂志,2013,27(5):457-459.
[9]张斌,姬社青,陈小兵,等.进展期胃癌新辅助化疗疗效及对手术风险影响[J].中华实用诊断与治疗杂志,2011,25(2):162-164.
[10]LI Z Y,KOH C E,BU Z D,et al.Nedadjuvant chemotherapy with FOLFOX:improved outcomes in Chinese patients with locally advanced gastric cancer[J].J Surg Oncol,2012,105(8):793-796.
[11]谭黄业,樊献军,马恒涛,等.快速康复外科理念在胰腺横断伤围手术期处理中的应用价值[J].中华实用诊断与治疗杂志,2014,28(11):1097-1098.
[12]吴庆邦.快速康复外科在胃癌手术中的应用效果[J].现代诊断与治疗,2014,25(13):3015-3016.
[13]吴斌,张光年,邓大炜,等.快速康复外科在大范围肝切除术围手术期中的应用[J].中华实用诊断与治疗杂志,2017,31(1):36-38.
[14]汪海,吴佩.快速康复外科在胃癌围手术期中的应用进展[J].牡丹江医学院学报,2015,36(6):96-99.
[15]张理想,徐阿曼,韩文秀,等.快速康复外科在胃癌中的应用[J].安徽医药,2017,21(5):948-951.