中国实用外科杂志

中国实用外科杂志

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加速康复外科理念在胃癌根治术中应用安全性及可行性分析

王俊江1，罗志坚1，2[Author]) AND 1[Journal]) AND year[Order])" target="_blank">2，冯兴宇1，李    胜1，3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3，4，黎伟豪1，3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3，胡伟贤1，3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3[Author]) AND 1[Journal]) AND year[Order])" target="_blank">3，吕泽坚1，郑佳彬1，杨梓锋1，李    勇1，姚学清1,2[Author]) AND 1[Journal]) AND year[Order])" target="_blank">2   

  1. 1广东省人民医院（广东省医学科学院）普外科胃肠专业组，广东广州510080；2汕头大学，广东汕头515063；3南方医科大学，广东广州510515；4邵阳市中心医院胃肠外科，湖南邵阳422000
  • 出版日期:2017-03-01 发布日期:2017-03-02

  • Online:2017-03-01 Published:2017-03-02

摘要：

目的    观察加速康复外科（ERAS）理念在胃癌根治术中应用的安全性及可行性。方法    回顾性分析广东省人民医院普外科胃肠专业组2015年7月至2016年1月收治的57例行D2根治手术的胃癌病人临床资料，根据围手术期是否应用ERAS理念处理分为ERAS组（21例）及传统组（36例）。结果    ERAS组与传统组相比，肛门排气时间提前［（2.95±1.36）d vs.（4.44±1.95）d，P=0.003］，腹腔引流管留置数量及时间减少［（0.95±0.50）根vs.（2.03±0.45）根，P=0.000］、［（5.05±3.64）d vs. （8.69±5.40）d，P=0.008］，术后经口进食时间提前［（1.71±2.39）d vs.（5.39±2.54）d，P=0.000］，术后下床活动时间提前［（2.14±1.42）d vs.（3.47±1.80）d，P=0.005］，术后住院时间缩短［（6.48±3.40）d vs.（10.56±6.54）d，P=0.010］，住院费用减少［（68 270.57±13 277.11）元 vs. （81 068.18±27 187.35）元，P=0.021］，术后疼痛减轻，两组病人术后6、12、24及48 h数字疼痛评分逐渐减少（P=0.001，0.000，0.000，0.000）；两组术后并发症发生率为9.5% vs.11.1%（P=1.000），两组病人无围手术期死亡病例，术后1个月内均无再入院病例。结论    胃癌根治术病人应用ERAS理念可以促进术后胃肠功能恢复，减轻术后疼痛，缩短住院时间，减轻经济负担。ERAS理念应用于胃癌根治术安全可行。

关键词: 胃癌, 胃切除术, 加速康复外科, 围手术期

Abstract:

Safety and feasibility for enhanced recovery after surgery management in gastric cancer patients under gastrectomy        WANG Jun-jiang*, LUO Zhi-jian，FENG Xing-yu，et al. *Group of Gastrointestinal, Department of General Surgery, Guangdong General Hospital（Guangdong Academy of Medical Sciences）, Guangzhou 510080, China
Corresponding authors：YAO Xue-qing,E-mail:yjb9211@21cn.com;LI-Yong, E-mail:yuan821007@126.com
Abstract    Objective    To investigate the safety and feasibility of enhanced recovery after surgery (ERAS) management in gastric cancer patients under gastrectomy. Methods    A total of 57 patients with gastric cancer performed D2 gastrectomy in Group of Gastrointestinal, Department of General Surgery, Guangdong General Hospital from July 2015 to January 2016 were divided into ERAS group(21 cases) and routine group according to the different approaches of the perioperative management(36 cases). The general information，postoperative recovery，inflammatory marks and the numeric rating scale were compared between the two group. Results ERAS group was associated with shorter time to bowel function ［（2.95±1.36）d vs.（4.44±1.95）d，P=0.003］， shorter and less intraperitoneal catheter drain ［（0.95±0.50）vs.（2.03±0.45），P=0.000］， ［（5.05±3.64）d vs.（8.69±5.40）d，P=0.008］，early oral feeding ［（1.71±2.39）d vs.（5.39±2.54）d，P=0.000］， early mobilization ［（2.14±1.42）d vs.（3.47±1.80）d，P=0.005］， shorter hospital stay ［（6.48±3.40）d vs.（10.56±6.54）d，P=0.010］， lower hospital cost［（68 270.57±13 277.11）yuan vs. （81 068.18±27 187.35）yuan，P=0.021］，lower pain score at the time 6h， 12h， 24h，48h after surgery. While the postoperative complication rate of ERAS group was 9.5%，and the routine group was 11.1%， which had no statistic difference（P＞0.05）.There was no different with death case and the readmission rate within 1 month. Conclusion    ERAS management in gastric cancer patients under gastrectomy is safe and feasible，accelerates gastrointestinal peristalsis，eases the pain，decreases postoperative stay.

Key words: gastric carcinoma, gastrectomy, enhanced recovery after surgery(ERAS), perioperative period