加速康复外科在胸腹腔镜食管癌术中的临床应用  

Clinical application of enhanced recovery after surgery in thoracoscopic and laparoscopic esophagectomy for esophageal cancer

作　　者：陈先凯 李印 刘先本 孙海波 张瑞祥 王总飞 郑燕 

机构地区：[1]郑州大学附属肿瘤医院胸外科,450000

出　　处：《中华消化外科杂志》2015年第12期987-992,共6页Chinese Journal of Digestive Surgery

基　　金：河南省卫生厅科技攻关计划项目（2011020157）

摘　　要：目的 探讨加速康复外科在胸腹腔镜食管癌术中的应用价值及可行性.方法 回顾性分析2013年12月至2014年7月郑州大学附属肿瘤医院收治的304例食管癌患者的临床资料.患者均在全身麻醉下行胸腹腔镜食管胃部分切除食管胃颈部吻合及胸腹腔二野淋巴结全清扫术;两组患者手术均由同一主刀医师完成.其中195例患者围术期行加速康复外科治疗,设为加速康复组;109例患者围术期行传统治疗,设为对照组.观察指标包括：（1）肠内肠外营养支持治疗情况.（2）营养学指标：血清Alb及前白蛋白水平.（3）胃肠功能恢复情况：术后肛门首次排气时间及排便时间.（4）术后并发症发生情况,并依据Clavien标准进行分级.（5）术后住院时间及术后治疗费用.（6）单因素分析影响食管癌术后并发症发生率的危险因素.（7）多因素分析影响食管癌术后并发症发生率的独立危险因素.正态分布的计量资料以x^-±s表示,采用t检验;偏态分布的计量资料采用Wilcoxon秩和检验.重复数据比较采用重复测量方差分析.分类变量采用卡方或Fisher确切概率法检验,连续变量的多因素分析采用多重线性回归分析,二分类变量多因素分析采用Logistic回归分析.结果 （1）肠内肠外营养支持治疗情况：加速康复组中11例患者因发生手术相关并发症,术后第1天未能经口进食;26例患者因进食热量未达到基础需要量的80％,术后第4天未能停止静脉补液.对照组患者肠内营养支持治疗耐受良好.（2）营养学指标比较：加速康复组患者术后1、3、5 d Alb分别为（37.2±3.9） g/L、（39.1 ±3.5）g/L、（38.5±3.0） g/L,对照组分别为（37.7±2.8）g/L、（39.0±3.6） g/L、（38.4±3.8）g/L;加速康复组患者术后1、3、5d前白蛋白分别为（0.20±0.06）g/L、（0.13±0.04）g/L、（0.13±0.04） g/L,对照组分别为（0.18±0.06） g/L、（0.13±0.04）g/L、（0.13 ±0.04�Objective To investigate the application value and feasibility of enhanced recovery after surgery （ERAS） in thoracoscopic and laparoscopic esophagectomy for esophageal cancer.Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed.All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia.The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group.Observing indicators included ： （1） enteral and parenteral nutritional support treatments;（2） nutrient indexs： levels of serum albumin （Alb） and prealbumin;（3） the recovery of gastrointestinal function： time to anal exsufflation and defecation;（4） postoperative complications and the grading according to Clavien standard;（5） duration of postoperative hospital stay and treatment expenses;（6） risk factors affecting postoperative complications by multivariate analysis;（7） independent risk factors affecting occurrence rate of postoperative complications by univariate analysis.Measurement data with normal distribution were presented as x^- ± s and analyzed using the t test.Nonnormal distribution data were analyzed by the Wilcoxon rank sum test.Comparison of repeated data was analyzed by the repeated measures ANOVA.Categorical variables were analyzed using the chi-square test or Fisher＆#39;s exact probability.The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively.Results （1） During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn＇t receive oral intake at postoperative day 1,26

关 键 词：食管肿瘤 胸腹腔镜食管切除术 加速康复外科 

分 类 号：R735.1[医药卫生—肿瘤]