Clinical study on fast track surgery in patients with gastric cancer

doi:j.issn.1009-976X.2013.05.017

Abstract

Abstract:

【Abstract】 Objective To evaluate the safety and efficacy of clinical application of fast track surgery (FTS) in patients with gastric cancer. Methods A retrospective clinical data were studied in 184 patients with gastric cancer. All patients were divided into two groups: FTS program group (n=92 cases, accepted FTS management) and traditional treatment group(n=92). The operation and postoperative indexes were compared between the two groups. Results There was no significant difference between the two groups in operation time (182±43 min vs 190±46 min,P=0.6845), operation bleeding (179±64 mL vs 183±75 mL, P=0.52), lymph node dissection number (21.2±7.2 vs 20.8±8.7,P=0.59) and complications (8.70% vs 10.87%,P=0.17). There was significant difference in first passing flatus (3.55±0.56 d vs 4.97±0.78 d, P<0.01), postoperative hospital stay (7.06±1.42 d vs 11.45±1.96 d,P<0.001) and hospitalization expense (40583±3693 Yuan vs 46438±6311 Yuan, P<0.001). Conclusion In our study, FTS management in patients with gastric cancer is safe and effective, and it would accelerate postoperative rehabilitation.

Key words: Fast track surgery, Gastric cancer

摘要：

【摘要】目的探讨快速康复外科理念在胃癌患者中临床应用的安全性和有效性。方法回顾性研究184例胃癌患者临床资料,一组为快速康复外科组,另一组为传统治疗组,每组92例。比较两组患者的手术及术后恢复相关评价指标。结果快速康复外科组与传统治疗组相比,在手术时间(182±43 min vs 190±46 min,P=0.68)、术中出血量(179±64 mL vs 182.59±74.65 mL,P=0.52)、淋巴结清扫数(21.2±7.2个vs 20.8±8.7个, P=0.59)、术后并发症(8.70% vs 10.87%,P=0.17)比较无显著性差异。而术后首次排气时间(3.6±0.6 d vs 5.0±0.8 d,P<0.01)、术后住院天数(7.1±1.4 d vs 11.5±2.0 d,P<0.001)和住院总费用(40583±3693元 vs 46438±6311元,P<0.001)比较有显著性差异。结论快速康复外科理念应用于胃癌患者安全有效,可明显加快胃癌患者术后康复进程。

关键词: 快速康复外科, 胃癌

CLC Number:

R656.6

Han Weifeng, Fei Bojian, Jiang Hui, Gao Qizhong, Du Jun. Clinical study on fast track surgery in patients with gastric cancer[J]. Lingnan Modern Clinics in Surgery, 2013, 13(05): 427-430.

韩伟峰费伯健蒋晖高其忠杜军. 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(05): 427-430.

References

[1]Christensen H K,Thaysen H V,Rodt S A, et al. Short hospital stay and low complication rate are possible with a fully implemented fast track model after elective colonic surgery[J]．Eur Surg Res, 2011, 46(3) :156-161.
[2]Gouvas N,Tan E,Windsor A,et al.Fast-track vs standard care in colorectal surgery:a meta-analysis update[J].Int J Colorectal Dis,2009,24(10):1119-1131.
[3] 何志国,唐云,吴会国,等.快速康复外科在胃癌患者围手术期应用的临床效果[J].中华临床营养杂志,2010,12(1):29-32.
[4] 王刚,江志伟,鲍扬,等.快速康复外科在老年人结直肠手术中的应用[J].中国普通外科杂志,2011,20 (4 ):406-410.
[5] 程黎阳,谢正勇,戴观荣,等.快速康复外科应用于胃肠手术的安全性评估及个体化原则[J].实用医学杂志,2012.28（01）:14-17.
[6] Slim K,Vicaut E,Panis Y,et a1.Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation[J].Br J Surg,2004,91(9):1125- 1130.
[7] Carrere N,Seulin P,Julio CH,et a1.Is nasogastric or nasojejunal decompression necessary after gastrectomy ? A prospective randomized trial [J].World J Surg,2007,31(1):122-127.
[8]王建忠,江志伟,鲍扬，等.胃肠道手术中不常规留置胃肠减压管并早期进食的临床应用研究[J].中国实用外科杂志,2009,29(4):331-332.
[9] Soop M,Nygren J,Myrenfors P,et a1.Preoperative oral carbohydrate treatment attenuate immediate postoperative insulin resistance[J]．Am J Physiol Endocrinol Metab,2001,280 (4):E576-E583.
[10] Lobo D N,Bostock K A,Neal K R,et a1.Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection:a randomised controlled trial.Lancet,2002,359 (9320 ):1812-1818.
[11] Tanguy M,Seguin P,Maliedant Y.Bench-to-bedside review : Routine postoperative use of the nasogastric tube-utility or futility[J].Crit Care, 2007,11 (1):201.
[12]Kim JW, Kim WS, Cheong JH et al. Safety and Efficacy of Fast-track Surgery in Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Clinical Trial[J]. World J Surg. 2012 ,36(12):2879-87.
[13]Chen Hu J, Xin Jiang L,Cai L et al.Preliminary experience of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer[J]. J Gastrointest Surg.2012 ,16(10):1830-9.
[14] 李正荣,曹毅,揭志刚,等. 快速康复外科在手辅助腹腔镜胃腺癌根治术中的应用[J].广东医学,2012,33(2):196-198.

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