加速康复外科理念指导腹腔镜胃癌根治术临床价值研究  

Fast track surgery in laparoscopic gastrectomy for gastric cancer

作　　者：赵坤[1,2] 王刚[1,2] 江志伟[1,2] 刘凤涛[1,2] 潘华锋[1,2] 李宁[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 解放军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2013年第7期587-589,共3页Chinese Journal of Practical 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：目的重点观察在加速康复外科(FTS)新理念指导下行腹腔镜胃癌根治术的安全性和有效性。方法对2008-2011年南京军区南京总医院120例胃癌手术病人的临床资料进行回顾性对照研究。将择期胃癌手术病人分为3组,每组40例。A组采取传统的围手术期处理方法行剖腹手术;B组应用FTS理念行剖腹手术;C组应用FTS理念行腹腔镜手术。比较3组病人手术时间、出血量、淋巴结清扫数量、术后开始下床时间、肠功能恢复时间、术后住院时间、并发症和住院费用等。结果 C组病人术中出血量明显减少(P<0.01),但手术时间明显延长(P<0.01),治疗费用显著增加(P<0.01)。3组间淋巴结清扫数量差异无统计学意义。C组与A组比较,病人术后肠功能恢复时间显著提前(P<0.01),术后住院时间明显缩短(P<0.01)。C组与B组比较,病人肠功能恢复时间和术后住院时间差异无统计学意义(P>0.05)。结论在FTS理念指导下应用腹腔镜行胃癌手术,可缩短术后住院时间,加快肠功能恢复。但与FTS剖腹手术相比,优势并不十分明显。Objective To evaluate the safety and effectiveness of fast track surgery in ]aparoscopic gastrectomy for gastric cancer. Methods The clinical data of 120 patients with gastric cancer performed gastrectomy between 2008 and 2011 in Nanjing General Hospital of Nanjing Military Command PLA were analyzed retrospectively. All patients received elective gastric cancer resection, and were divided into three groups： group A （open gastrectomy, n=40） , group B （open gastrectomy with fast track surgery, n=40） and group C （ laparoscopic gastrectomy with fast track surgery, n=40）. The clinical data and gut function were assessed in three groups. Results There were no significant differences in postoperative complication and the number of lymph node harvest between 3 groups. Blood loss was less in group C than group A and group B （P〈0.01） , but its operative time was longer and its cost was more than other two open surgery groups （P〈0.01）. Recovery of bowel function in group C was faster, and postoperative hospital stay was shorter than group A （P〈0.01）. However, recovery of bowel function and postoperative hospital stay in group C were not different from group B （P〉0.05）. Conclusion Postoperative hospital stay can be shorter and recovery of bowel function can be faster in laparoscopic gastrectomy with fast track surgery plan compared with traditional care group. But when using fast track surgery plan, laparoscopic gastrectomy is not superior to open surgery.

关 键 词：胃癌 加速康复外科 腹腔镜 

分 类 号：R6[医药卫生—外科学]