术前营养支持在腹腔镜右半结肠癌根治术快速康复治疗中的临床意义  

Clinical Significance of Preoperative Nutritional Support Based on Fast Track Surgery Guideline in Laparoscopic-assisted Radical Right Hemi-colectomy

作　　者：林天胜[1] 张庆洪[2] 蔡桦立 熊迪生 尤俊[1] 

机构地区：[1]厦门大学附属第一医院厦门市肿瘤医院胃肠肿瘤外科,厦门361003 [2]厦门大学附属第一医院厦门市肿瘤医院麻醉手术科,厦门361003

出　　处：《中国微创外科杂志》2017年第8期683-687,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨术前营养支持在腹腔镜右半结肠癌根治术后康复中的临床意义。方法回顾性分析2014年2月~2015年11月我科147例右半结肠癌的临床资料,其中68例接受快速康复治疗(fast track surgery,FTS),79例依我院常规执行围术期准备及处理,比较2组术后恢复情况及术后并发症等方面的差异。结果与常规组相比,FTS组在术后胃管留置时间[(1.6±0.6)d vs.(3.0±0.9)d,t=-10.565,P=0.000],腹腔引流管留置时间[(4.2±1.1)d vs.(9.3±2.3)d,t=-16.700,P=0.000],导尿管留置时间[(3.3±0.8)d vs.(3.7±1.0)d,t=-2.804,P=0.006],首次下地活动时间[(2.2±0.4)d vs.(2.5±0.6)d,t=-3.506,P=0.000],首次肛门排气时间[(3.4±0.9)d vs.(3.8±0.8)d,t=-2.853,P=0.002]以及术后住院时间[(8.6±2.7)d vs.(12.4±2.3)d,t=-9.369,P=0.000]明显缩短,而首次肛门排便时间无显著性差异[(4.5±1.1)d vs.(4.8±1.2)d,t=-1.570,P=0.059]。与常规组相比,FTS组术后非手术部位感染的发生率减少[1.5%(1/68)vs.11.4%(9/79),χ~2=4.217,P=0.040],而手术部位感染的发生率无显著差异[4.4%(3/68)vs.11.4%(9/79),χ~2=2.375,P=0.123]。结论基于FTS指南的术前营养支持减少了腹腔镜右半结肠癌根治术后非手术部位感染相关并发症,缩短术后住院时间,可使患者受益。Objective To investigate the impact of preoperative nutritional support based on fast track surgery（ FTS）guideline in laparoscopic-assisted radical right hemi-colectomy. Methods The study was a single center retrospective analysis based on cases from February 2014 to November 2015,147 cases in total,including 68 cases of FTS and 79 cases of routine treatment,to analyze the impact of preoperative nutritional support on the complication rate and outcome of patients. Results Compared with the routine group,the FTS group had significantly reduced duration of nasogastric intubation [（ 1. 6 ± 0. 6） d vs.（ 3. 0 ± 0. 9） d,t =-10. 565,P = 0. 000],peritoneal cavity drainage [（ 4. 2 ± 1. 1） d vs.（ 9. 3 ± 2. 3） d,t =-16. 700,P = 0. 000],urinary drainage[（ 3. 3 ± 0. 8） d vs.（ 3. 7 ± 1. 0） d,t =-2. 804,P = 0. 006],first postoperative walk [（ 2. 2 ± 0. 4） d vs.（ 2. 5 ± 0. 6） d,t =-3. 506,P = 0. 000 ],postoperative anal exhaust [（ 3. 4 ± 0. 9） d vs.（ 3. 8 ± 0. 8） d,t =-2. 853,P = 0. 002] and the postoperative hospital stay [（ 8. 6 ± 2. 7） d vs.（ 12. 4 ± 2. 3） d,t =-9. 369,P = 0. 000]. The postoperative anal defecate [（ 4. 5 ±1. 1） d vs.（ 4. 8 ± 1. 2） d,t =-1. 570,P = 0. 059] had no significant difference. The short-term complications were also proved with less occurrence as compared with the control group. Compared with the routine group,the FTS group developed less non surgical site infection [1. 5%（ 1/68） vs. 11. 4%（ 9/79）,χ^2 4. 217,P = 0. 040],however,the occurrence of surgical site infection was not significantly reduced [4. 4%（ 3/68） vs. 11. 4%（ 9/79）,χ^2 2. 375,P = 0. 123]. Conclusion The preoperative nutritional support based on FTS guideline is beneficial in patients received laparoscopic-assisted radical right hemi-colectomy.

关 键 词：术前营养支持 快速康复外科 腹腔镜 右半结肠癌根治术 

分 类 号：R735.35[医药卫生—肿瘤]