引用本文:张凯光,周小海,郝建朋,关泉林.加速康复外科模式在腹腔镜胃癌根治术中的应用[J].中国临床新医学,2019,12(11):1155-1158.
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加速康复外科模式在腹腔镜胃癌根治术中的应用
张凯光,周小海,郝建朋,关泉林
730000 甘肃,兰州大学第一临床医学院(张凯光,周小海);730000 甘肃,兰州大学第一医院肿瘤外科(郝建朋,关泉林)
摘要:
[摘要] 目的 观察在加速康复外科(ERAS)模式指导下行腹腔镜胃癌根治术治疗胃癌的安全性和有效性。方法 对2018-05~2018-10兰州大学第一医院肿瘤外科收治的51例行胃癌手术患者的临床资料进行回顾性对照研究,按治疗方式的不同分为两组。应用传统开腹+ERAS模式的27例为A组,应用腹腔镜手术+ERAS模式的24例为B组。比较两组术前白细胞(WBC)计数和D-二聚体水平、手术时间、术中出血量、淋巴结清扫数目、切口长度、首次经口进食时间、首次肛门排气时间、腹腔引流管放置天数、术后住院时间、住院费用、并发症及死亡发生情况、术后第1天、第3天WBC计数和D-二聚体水平等。结果 B组在术中出血量、皮肤切口长度、首次经口进食时间、首次肛门排气时间、腹腔引流管放置天数均优于A组,差异有统计学意义(P<0.05),但手术时间延长(P<0.05),住院费用增高(P<0.05)。两组患者淋巴结清扫数目、术后住院天数、术后并发症发生率及术前1 d、术后第1天、术后第3天WBC计数及D-二聚体定量比较差异均无统计学意义(P>0.05)。结论 与传统开腹手术+ERAS模式相比,腹腔镜手术+ERAS模式具有加快术后肠道功能恢复、缩短腹腔引流管放置天数、减少术中出血量等优点。加速康复外科模式可安全、有效地在腹腔镜胃癌根治术中展开实施。
关键词:  加速康复外科  腹腔镜  胃癌根治术
DOI:10.3969/j.issn.1674-3806.2019.11.02
分类号:R 735.2
基金项目:
Application of enhanced recovery after surgery in laparoscopic gastric cancer radical surgery
ZHANG Kai-guang, ZHOU Xiao-hai, HAO Jian-peng, et al.
The First Clinical Medical College of Lanzhou University, Gansu 730000, China
Abstract:
[Abstract] Objective To observe the safety and efficacy of laparoscopic radical gastrectomy for gastric cancer under the guidance of enhanced recovery after surgery(ERAS). Methods A retrospective controlled study was performed on 51 patients undergoing gastric cancer surgery from May 2018 to October 2018 in Department of Oncological Surgery, the First Hospital of Lanzhou University. The patients with gastric cancer were divided into two groups according to different treatment modes. Group A received traditional open laparotomy+ERAS mode(27 cases) and group B received laparoscopic surgery+ERAS mode(24 cases). The levels of preoperative white blood cell(WBC) count and D-dimer were detected and the operation time, the intraoperative blood loss, the lymph nodes dissected, the incision length, the first oral feeding time, the first anal exhaust time, the days of abdominal drainage tube placement, the postoperative hospitalization time, the hospitalization costs, and the incidence of complications and death were recorded. The levels of WBC count and D-dimer were checked respectively on the first day and the third day after operation. Results The intraoperative blood loss, the skin incision length, the first oral feeding time, the first anal exhaust time and the days of abdominal drainage tube placement in the group B were better than those in the group A(P<0.05), but the operation time was longer(P<0.05) and the hospitalization costs were higher in the group B(P<0.05). There were no significant differences in the number of lymph nodes dissected, the postoperative hospital stay, the incidence of postoperative complications, and the levels of WBC and D-dimer on the first day before surgery, the first day after surgery and the third day after surgery(P>0.05). Conclusion Compared with the traditional open surgery+ERAS mode, laparoscopic surgery+ERAS mode has the advantages of speeding up the recovery of postoperative intestinal function, shortening the number of days of abdominal drainage tube placement and reduce intraoperative bleeding. ERAS mode can be safely and effectively implemented in laparoscopic radical gastrectomy.
Key words:  Enhanced recovery after surgery(ERAS)  Laparoscopy  Radical gastrectomy