营养及加速康复外科在结直肠癌围手术期中的应用  

The nutritional therapy and enhanced rehabilitation surgery in perioperative colorectal cancer

作　　者：魏丞[1] 滕文浩[1] 陈书[1] 何皓[1] 陈境鸿 廖凌虹[2] 臧卫东[1] 

机构地区：[1]福建省肿瘤医院/福建医科大学附属肿瘤医院胃肠肿瘤外科,福州350014 [2]福建中医药大学,福州350122

出　　处：《肿瘤代谢与营养电子杂志》2017年第3期291-296,共6页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：国家自然科学基金青年项目(81302885)

摘　　要：目的探讨围手术期营养治疗及加速康复外科技术在结直肠癌围手术期应用中的可行性和优势。方法回顾性分析110例cT1~4a N0~2M0结直肠癌患者资料,根据围手术期措施的不同,分为营养及加速康复组(62例)和传统治疗组(48例)。营养及加速康复组术前进行营养状况筛查及营养治疗,再进行腹腔镜根治手术,术中予麻醉期间保暖,切口镇痛泵置入,不留置引流管或早期拔除引流管;术后不置或早期拔除胃肠减压管,鼓励早期协助下床活动及流质饮食,并争取5天停静脉补液。传统治疗组则给予一般围手术期处理,对比两组围手术期情况。结果营养及加速康复组优化措施均可以顺利进行,术后平均排气时间、输液时间及术后住院时间分别为(2.2±0.8)天、(5.8±1.2)天和(7.8±1.5)天,均较传统治疗组缩短,差异有统计学意义(P<0.05)。此外,营养及加速康复组的肺部感染和腹腔感染发生率更低(P<0.05),术后5天内的疼痛评分也更低(P<0.05)。结论围手术期营养治疗和加速康复外科技术的应用可加速结直肠癌术后康复。Objective To explore the feasibility and advantages of perioperative nutritional therapy and accelerated rehabilitation surgery in the perioperative application of colorectal cancer. Methods A retrospective analysis on 110 cases of cT1~4a N0~2M0 colorectal cancer patients was performed. According to the different perioperative measures, they were divided into two groups, nutrition ERAS group（62 patients） and traditional treatment group（48 patients）. Before operation, the patients in nutrition ERAS group were screened and scored with preoperative nutritional status, and after treated by nutritional therapy, they werethen underwent laparoscopic radical surgery. During the operation, several measures would be performed including keep warmth during anesthesia, insert analgesic pump and remove the drainage tubes at early stage or even retain none tubes. Moreover, the gastrointestinal decompression tube was removed at early stage or not retain, and early off-bed activity and liquid diet would be encouraged to support treatment. What＇s more, we tried our best to give them 5 days intravenous fluids supplement. On the other hand, the patients in traditional treatment group were treated with common perioperative measures. Then the data would be compared between two groups. Results The averaged time of exsufflation, infusion days and postoperative hospital stay in nutrition ERAS group were（2.2±0.8） days,（5.8±1.2） days and（7.8±1.5） days respectively. And they were shorter than traditional treatment group significantly（P〈0.05）. Moreover, it showed less morbidity of pulmonary infection and abdominal infection, and less pain score in 5 days after operation（P〈0.05）. Conclusions The application of perioperative nutrition therapy and accelerated rehabilitation surgery could accelerate the rehabilitation of colorectal cancer.

关 键 词：营养 加速康复外科 围手术期 术后康复 结直肠癌 

分 类 号：R473.73[医药卫生—护理学]