快速康复外科在微创食管癌切除术中的应用  

Outcomes of fast track surgery program used in minimally invasive esophagectomy

作　　者：王琪[1] 吴明[1] 沈钢[1] 徐小方[1] 陈刚[1] 潘赛波[1] 

机构地区：[1]浙江大学医学院附属第二医院胸外科,杭州310009

出　　处：《中华胸心血管外科杂志》2013年第6期349-353,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的观察在胸腹腔镜联合食管癌根治术患者中应用快速康复外科的围手术期疗效。方法2010年3月至2012年12月，99例食管癌患者随机抽签分组，接受胸腹腔镜联合食管癌根治术（微创组，50例）和开放食管癌根治术（开放组，49例）。除肠内营养置管方式外，两组采用相同的快速康复外科方案。收集患者围手术期资料。计量资料数据经正态性分析，正态分布数据以元±s表示，采用两独立样本的t检验；非正态分布数据以中位数（最小值一最大值）表示，采用非参数检验。各时间点数据经对数转换后，符合平行性检验的采用含有重复测量设计的协方差分析，不符合平行性检验的采用单因素协方差分析和配对t检验。计数资料采用疋。检验。结果术前两组临床资料差异无统计学意义。术中清扫腹部淋巴结数，微创组多于开放组[13（6～40）枚对4（0～20）枚，P〈0．05]。同组内比较，两组患者总白蛋白、血红蛋白和总胆固醇水平术后第8天均优于术后第1天（P〈0．05）。微创组术后48h自控镇痛泵使用少（74．0％对94．9％，P〈0．05），术后镇痛效果好，术后疼痛评分低（48h安静／活动0．0／1．0对1．0／2．0，P〈0．05）。微创组术后肌酸激酶水平、术后第8天白细胞计数和C-反应蛋白水平低于开放组（74．O％对94．9％，P〈0。05）。微创组患者肠外营养使用时间短[（7．9±2．4）天对（8．6±2．9）天，P〈0．05]，进食时间早（6天对9天，P〈0．05），术后住院时间短[（12．5±3．1）天对（17．1±6．3）天，P〈0．05]。结论食管癌根治术中应用快速康复外科安全、可行。对微创食管癌切除术患者采用快速康复外科，在减轻患者术后疼痛、改善营养状况、减少炎症反应和缩短住院时间等方面更具优势。Objective To observe the outcomes of fast track surgery program applied in esophagectomy. Methods From March 2010 to December 2012, 99 esophagus cancer patients were randomly allocated to re- ceive thoracoscopic/laparoscopic esophagectomy [ minimally invasive esophagectomy （MIE） group, 50 cases ] and open esoph- agectomy[ open esophagectomy （OE） group, 49 cases]. Same fast track surgery program was applied in both groups. Perioper- ative data of all patients were eoUected and analysized. Results The baseline of both groups was similar. Compared with OE group, MIE group got more abdominal lymph nodes resection, 13 （6 - 40 ） vs. 4 （0 - 20 ）, P 〈 0.05. In both groups, the level of the total albumin, hemoglobin and total cholesterol in the 8th postoperative day was higher than that of the 1st postoperative day, P 〈0.05. Statistical difference was observed in the 48 h patient controlled analgesia usage, 24 h and 48h visual analogue scales score of motion and less motion, postoperative creatine kinase level, the white cell count and C-reaction protein level in the 8th postoperative day, of which the MIE group got better results, P 〈0.05. Patients in MIE group took less time to begin oral nutrition（6 days vs. 9 days P 〈 0.05 ）, besides, the parenteral nutrition duration [ （ 7.9 ~ 2.4 ） days vs. （ 8.6 ＋ 2.9 ） days, P 〈 0. 05 ] and postoperative hospital stay [ （ 12. 5 ~ 3.1 ） days vs. （ 17. 1 ＋ 6. 3 ） days, P 〈 0. 05 ] were also shorter, P 〈 O. 05. Conclusion Fast track surgery program is safe and feasible for patients receiving esephagectomy. MIE combined with fast track surgery program can promote early rehabilitation by easing pain, reducing inflammatory response, improving nutrition state, lowering postoperative morbidity, shortening hospital stays, and as a result, have more obviously advantages.

关 键 词：食管肿瘤 胸外科手术 电视辅助 快速康复外科 

分 类 号：R735.1[医药卫生—肿瘤]