加速康复外科对腹腔镜辅助结直肠癌根治术后患者免疫功能及近期结局的影响  

The effect of enhanced recovery after surgery combined with laparoscopy-assisted surgery for the colorectal cancer on immunity and recent clinical outcomes

作　　者：王希[1] 黄建华[1] 罗浩元[1] 刘习红[1] 冯丽光[1] 肖凌晖[1] 曾惠明[1] WANG Xi ttUANG Jian-hua LUO Hao-yuan et al(Department of Gastrointestinal Surgery,the First People＇ s Hospital of Huizhou , Huizhou 516001, China)

机构地区：[1]惠州市第一人民医院,广东惠州516001

出　　处：《腹腔镜外科杂志》2016年第11期837-841,共5页Journal of Laparoscopic Surgery

基　　金：惠州市科技计划项目(编号:2014Y060)

摘　　要：目的:探讨加速康复外科措施对腹腔镜辅助结直肠癌根治术后患者免疫功能及近期结局的影响。方法:选取120例行腹腔镜辅助结直肠癌根治术的患者,随机分为常规治疗组(n=60)与加速康复组(n=60),对比分析两组患者围手术期C反应蛋白、免疫球蛋白(IgA、IgM、IgG)、白细胞介素6、外周血T细胞亚群(CD3^+、CD4^+、CD8^+)的水平及近期临床指标的变化情况。结果:患者均顺利完成手术,无一例中转开腹。术后第3天、第7天,加速康复组免疫指标恢复情况较常规治疗组理想,差异有统计学意义(P<0.05);加速康复组术后首次排气时间[(1.6±0.5)dvs.(3.6±0.7)d]、排便时间[(3.8±0.7)dvs.(5.6±0.7)d]、进半流质饮食时间[(2.6±0.7)dvs.(4.5±0.4)d]具有明显优势,感染并发症(肺部感染、泌尿系感染)(6vs.24)、深静脉血栓(0vs.6)、术后住院时间[(5.7±0.8)dvs.(12.1±2.7)d]、总住院时间[(10.4±0.8)dvs.(14.7±1.4)d]及总住院费用[(48874±785)元vs.(54935±823)元]均明显减少,差异有统计学意义(P<0.05)。结论:加速康复外科措施应用于腹腔镜辅助结直肠癌根治术安全、可靠,在促进术后免疫功能恢复、减少并发症、缩短住院时间、节约医疗成本方面优势明显。Objective： To evaluate the effect of enhanced recovery after surgery（ ERAS） combined with laparoscopy-assisted surgery for the colorectal cancer on immunity and recent clinical outcomes. Methods： One hundred and twenty patients who received laparoscopy-assisted surgery for the colorectal cancer were randomly divided into two groups： ERAS group（ n = 60,ERAS combined with laparoscopy-assisted surgery） and conventional care group（ n = 60,only laparoscopy-assisted surgery）. Serum levels of IgA,IgM,IgG,CRP,CD3~＋,CD4~＋,CD8~＋,and IL-6 in 120 patients were assayed preoperatively and postoperatively on 1st,3rd,7th day. The average length of hospital stay,postoperative complications,the time of first flatus and defecation,hospitalization expenses were recorded respectively. Results： The 120 patients finally completed the laparoscopy-assisted surgery,no one was converted to open surgery. The speed of recovery of the immunologic function on 3rd,7th postoperative day in the ERAS group was significantly faster than the conventional care group（ P 〈 0. 05）. The infectious complication（ pulmonary and urinary infection） rate（ 6 vs. 24） and the occurrence of deep venous thrombosis（ 0 vs. 6） in the ERAS group were significantly lower than the conventional care group（ P 〈 0. 05）. The time to first flatus[（ 1. 6 ± 0. 5） d vs.（ 3. 6 ± 0. 7） d],defecation [（ 3. 8 ± 0. 7） d vs.（ 5. 6 ± 0. 7） d]and eating semi-liquid [（ 2. 6 ± 0. 7） d vs.（ 4. 5± 0. 4） d],the length of postoperative hospital stay [（ 5. 7 ± 0. 8） d vs.（ 12. 1 ± 2. 7） d],the total length of hospital stay [（ 10. 4 ±0. 8） d vs.（ 14. 7 ± 1. 4） d] and the total hospitalization expenditure [（ 48 874 ± 785） yuan vs.（ 54 935 ± 823） yuan] in the ERAS group were significantly less than those in the conventional care group（ P 〈 0. 05）. Conclusions： ERAS combined with laparoscopy-assisted surgery for the colorectal cancer is safe and reliable. ERAS could significantly a

关 键 词：加速康复外科 结直肠肿瘤 腹腔镜检查 免疫 近期治疗结果 

分 类 号：R735.34[医药卫生—肿瘤]