快速康复外科在肝癌围手术期的应用研究  

Application research of fast track surgery in perioperative patients with hepatocellular carcinoma

作　　者：郑惊雷[1] 王在国[1] 游志坚[1] 李绍强[2] 赖佳明[2] 彭宝岗[2] 林志强[1] 陈刘镇[1] 李庆贤[1] 梁力建[2] 

机构地区：[1]东莞市人民医院肿瘤外科,广东东莞523059 [2]中山大学附属第一医院肝胆外科,广东广州510080

出　　处：《中国肿瘤外科杂志》2015年第5期273-277,共5页Chinese Journal of Surgical Oncology

基　　金：广东省科技计划项目(2011B020800001);广东省医学科研基金(B2010324);东莞市科技计划项目(2010105150009)

摘　　要：目的研究快速康复外科(fast track surgery,FTS)在肝癌围手术期应用的有效性和安全性,为临床提供参考。方法选取2010年11月1日至2014年6月30日行肝癌切除患者80例,采用区组随机化将患者分为两组(快速康复外科组和传统治疗组),每组各40例,进行前瞻性随机对照研究。比较两组患者术前术后临床监测指标,肠道功能恢复情况,手术前后体重、上臂围(AC)和三头肌皮褶厚度(TSF);术前术后肝酶学和白蛋白、前白蛋白、血糖等营养代谢指标,以及术后并发症、再入院率、病死率,统计白蛋白总使用量、平均营养费用和总住院时间。结果快速康复外科组术后的首次排气排便时间、耐受半流时间均较传统治疗组明显缩短(P<0.05),术后第7天血清白蛋白、前白蛋白也明显高于传统治疗组(P<0.05)。两组之间感染性并发症和总并发症差异均无统计学意义。术后两组白蛋白用量相当,但快速康复外科组平均住院费用和住院时间均明显低于传统治疗组。结论快速康复外科应用在肝癌围手术期安全、有效。Objective To study the effect and safety of the application of fast track surgery （ FTS） in the perioperative period of hepatocellular carcinoma. Methods 80 hepatectomy cases of hepatocellular carcinoma from November 1, 2010 to June 30, 2014, were divided into two groups （fast track surgery group and conven-tional treatment group） by using block randomization for the prospective randomized controlled study. Each group had 40 cases. The clinical data including preoperational and post-operational clinical monitoring indexes, intestinal function recovery, liver enzymology, albumin, pre albumin, blood glucose value, complications, mor-tality, readmission rate, albumin consumption, cost of nutrition and total hospitalization time were compared and analyzed by statistics. Results Passing of flatus,defacating funtion, semi fluid tolerance time were significantly shorter than traditional treatment group（P〈0. 05）. On the postoperative seventh day, the serum albumin, pre-albumin of fast track surgery group were significantly higher than traditional treatment group（P〈0. 05）. There was no difference of the total complications and infectious complications between the two groups. The albumin＆amp;nbsp;consumption was equal in two groups, but the average hospitalization time and total expenses of fast track surger-y were significantly lower than that of traditional treatment group. Conclusion It is effective and safe for the application of fast track surgery in the peri-operative period of hepatocellular carcinoma.

关 键 词：肝癌 快速康复外科 围手术期 肠内营养 住院时间 

分 类 号：R735.7[医药卫生—肿瘤]