腹腔镜胃癌根治术后加速康复外科方案应用的体会

doi:10.3969/j.issn.1009-976X.2020.03.022

摘要/Abstract

摘要： 目的探索腹腔镜胃癌根治术后加速康复外科应用的体会。方法收集2018年2月~2019年10月因胃癌接受根治手术的患者执行加速康复外科方案的23例患者的临床资料（ERAS组）。另选择同期常规胃癌根治术23例患者作为对照（常规组）,手术方式均为5孔法腹腔镜辅助胃癌D2根治+胃背侧系膜近胃端CME术,ERAS方案执行参考文献报道。比较两组临床效果。结果与常规组相比,ERAS组术后住院时间缩短（分别为7.8±1.3 d和6.7±1.4 d）（P<0.05）;ERAS组术后早期进食量（3.1±0.8 d）较常规组（4.4±1.2 d）提前（P<0.05）;ERAS组的排便时间（3.3±0.8 d）与常规组（3.9±1.1 d）也有显著性差异（P<0.05）;活动时间（ERAS组：2.5±1.0 d,常规组：3.2±1.0 d）两组间也有显著差异（P<0.05）。ERA组与常规组的并发症发生率无显著性差异（P=0.437）。结论 ERAS组具有术后恢复快特点,但作者体会ERAS方案应用主要是根据手术医生术中和术后情况的经验判断,与患者个性化处理有关。

关键词: 腹腔镜胃癌根治术, 加速康复外科

Abstract: Objective To explore the application and experience of Enhanced Recovery After Surgery after laparoscopic gastrectomy. Methods The clinical data of 23 patients （ERAS group） who underwent laparoscopic gastrectomy for gastric cancer from February 2018 to October 2019 were collected and retrospectively analyzed. In addition, 23 patients with gastric cancer were selected as the controls （routine group）. Laparoscopic D2 radical gastrectomy combined with complete mesocolic excision was performed in all patients. ERAS protocol was implemented by referring to the previous literature. Results Compared with the routine group, the postoperative hospital stay in ERAS group was shorter （7.8±1.3 days and 6.7±1.4 days respectively）; the early postoperative food intake in ERAS group was earlier （2.9±0.7）days than that in routine group （3.5±0.8 days）; the defecation time in ERAs group was shorter （3.1±0.7）day than that in routine group （3.6 ± 0.8 days）. There were also significant differences in activity time （2.6±0.9 day in ERAS group and 3.1±1.0 days in routine group） between the two groups. There was no significant difference in the incidence of complications between Era Group and routine group （P=0.437）. Conclusion ERAS protocol has the characteristics of quick postoperative recovery, but the author realized that the application of ERAS protocol is mainly based on the experience of surgeons during and after the operation, which is related to the personalized treatment of patients.

Key words: laparoscopic-assisted D2 radical gastrectomy, Enhanced Recovery After Surgery

中图分类号:

R735.2

白英伟, 杨海林, 张怀波. 腹腔镜胃癌根治术后加速康复外科方案应用的体会[J]. 岭南现代临床外科, 2020, 20(03): 363-366.

BAI Ying-wei, YANG Lin-hai, ZHANG Huai-bo. Experience in the application of Enhanced Recovery After Surgery after laparoscopic gastrectomy[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 363-366.

参考文献

[1] Etoh T, Inomata M, Shiraishi N, Kitano S.Minimally invasive approaches for gastric cancer-Japanese experiences[J]. J Surg Oncol, 2013, 107(3): 282-288.
[2] Park DJ, Lee HJ, Kim HH, et al.Predictors of operative morbidity and mortality in gastric cancer surgery[J]. Br J Surg, 2005, 92(9): 1099-1102.
[3] Jeong SH, Lee YJ, Park ST, et al.Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon[J]. Surg Endosc, 2011, 25(3): 872-878.
[4] Tian Y, Cao S, Li L, et al.Effects of perioperative enhanced recovery after surgery pathway management versus traditional management on the clinical outcomes of laparoscopic-assisted radical resection of distal gastric cancer: study protocol for a randomized controlled trial[J]. Trials, 2020, 21(1): 369.
[5] 韩伟峰,费伯健,蒋晖,等. 快速康复外科理念在胃癌患者中的临床研究[J]. 岭南现代临床外科, 2013, 13(5): 427-430.
[6] Abdikarim I, Cao XY, Li SZ, et al.Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas[J]. World J Gastroenterol, 2015, 21(47): 13339-13344.
[7] Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4)[J]. Gastric Cancer, 2017, 20(1): 1-19.
[8] Abdikarim I, Cao XY, Li SZ, et al.Enhanced Recovery After Surgery With Laparoscopic Radical Gastrectomy for Stomach Carcinomas[J]. World J Gastroenterol, 2015, 21(47):13339-13344.
[9] Wang D, Kong Y, Zhong B, et al.Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care[J]. J Gastrointest Surg, 2010, 14(4): 620-627.
[10] Scatizzi M, Kröning KC, Boddi V, et al.Fasttrack surgery after laparoscopic colorectal surgery: is it feasible in a general surgery unit?[J]. Surgery, 2010, 147(2): 219-226.
[11] Ibrahim MS, Khan MA, Nizam I, Haddad FS.Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidencebased review[J]. BMC Med, 2013, 11: 37.
[12] Wang Q, Suo J, Jiang J, et al.Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial[J]. Colorectal Dis, 2012, 14(8): 1009-1013.