在快速康复外科理念指导下的腹腔镜结直肠癌根治术  

Laparoscopic radical surgery for colorectal cancer

作　　者：王刚[1,2] 江志伟[1,2] 龚剑峰[1,2] 鲍扬[1,2] 刘磊[1,2] 黎介寿[1,2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院解放军普外科研究所,210002

出　　处：《腹部外科》2010年第3期164-166,共3页Journal of Abdominal Surgery

基　　金：江苏省社会发展基金资助(BS2007054);南京军区科技创新基金资助(07Z028)

摘　　要：目的观察在快速康复外科(fast track surgery,FTS)理念指导下行腹腔镜结直肠癌手术的安全性与有效性。方法将择期行结直肠癌手术106例随机分成3组:常规开腹对照组(Ⅰ组,35例),应用传统围手术期处理行剖腹手术;快速康复开腹组(Ⅱ组,35例),应用FTS理念行剖腹手术;快速康复腔镜组(Ⅲ组,36例),应用FTS理念行腹腔镜手术。分析研究3组病人手术时间、出血量、淋巴结清扫数量、术后肠道通气时间、术后住院天数和住院费用等指标,并观察记录不良反应及并发症。结果Ⅲ组与Ⅰ、Ⅱ组相比,病人术中出血量明显减少,切口长度明显减短,但手术时间有所延长,以上各项差异均有统计学意义(P<0.05)。Ⅲ组与Ⅰ组相比,病人术后肠功能恢复时间明显提前,术后住院天数明显缩短,差异均有统计学意义(P<0.05)。Ⅲ组与Ⅱ组病人肠功能恢复时间和术后住院天数差异无统计学意义(P>0.05)。结论在FTS理念指导下应用腹腔镜结直肠手术,可缩短住院时间,加快肠功能的恢复;与FTS理念下剖腹手术相比,具有出血量少、切口小的优势,但手术时间延长、治疗费用增加。Objective To investigate the effectiveness, safety and advantage of fast track rehabilitation protocols in laparoscopic surgery for colorectal cancer. Methods I06 patients were randomized to receive traditional protocol and open surgery（group I , n = 35）, fast track protocols and open surgery（group II ,n = 35）, fast track surgery and laparoscopic surgery（group III, n = 36）. Results There was no significant difference in postoperative complication and the number of lymph harvest among three groups. Blood loss was less and incision length was shorter, and operative time was longer in group III than in groups I and II （all P〈0. 05）. Recovery of bowel function in group III was faster, and postoperative hospital stay was shorter in group III than in group I （P〈0. 05）, hut there was no significant difference between group III and group II （P〉0. 05）Conclusion Postoperative hospital stay can be shortened and recovery of bowel function can be accelerated in laparoscopie surgery with fast track rehabilitation compared to traditional care group. Compared to open surgery fast track reha- bilitation, blood loss was less and incision was smaller, but its operative time was longer and its cost was higher in laparoscopic surgery with fast track surgery protocols.

关 键 词：结直肠肿瘤 腹腔镜检查 手术期间 

分 类 号：R473.6[医药卫生—护理学]