快速康复外科理念在结肠癌合并肠梗阻病人中的应用分析  

The application of fast track surgery in colon cancer patients with intestinal obstruction

作　　者：黄致远[1] 刘勇[1] 梅洪亮[1] HUANG Zhiyuan;LIU Yong;MEI Hongliang(Department of General Surgery, Wuhan General Hospital of the Chinesepeople's Liberation Army, Wuhan 430070,China)

机构地区：[1]中国人民解放军武汉总医院普通外科,430070

出　　处：《临床外科杂志》2019年第5期404-407,共4页Journal of Clinical Surgery

摘　　要：目的探讨快速康复外科(fast track surgery, FTS)理念在结肠癌合并肠梗阻病人围手术期的应用价值与安全性。方法结肠癌合并肠梗阻病人72例,采用随机数表分为传统组(36例)与FTS组(36例),传统组按照传统外科理念行围手术期管理,FTS组按FTS理念行围手术期管理。比较两组病人术后VAS评分、首次离床时间、首次排气排便时间、首次进流食时间、住院时间、术后并发症等情况。结果 FTS组术后1天、3天VAS评分低于传统组(P<0.05),术后7天两组病人VAS评分比较差异无统计学意义(P>0.05)。FTS组与传统组首次离床时间分别为(17.66±12.10)小时和(26.37±10.70)小时,首次排气时间分别为(47.54±15.30)小时和(57.95±18.40)小时,首次排粪时间分别为(98.26±27.10)小时和(115.63±27.50)小时,首次进流质时间分别为(48.72±13.50)小时和(57.75±17.00)小时,出院时间分别为(5.85±2.20)天和(8.73±3.50)天,两组比较差异有统计学意义(P<0.05)。FTS组病人术后肺部感染、切口感染的发生少于传统组,术后腹胀、呕吐的发生多于传统组,两组比较差异有统计学意义(P<0.05)。两组病人术后腹腔内出血、腹腔内感染、吻合口狭窄等并发症以及并发症总体发生率比较无明显差异(P>0.05)。结论 FTS理念在结肠癌合并肠梗阻病人中安全有效,并未增加并发症的发生,有利于术后康复,缩短住院时间。Objective To investigate the clinical effects and safety of fast track surgery(FTS)in the colon cancer patients with intestinal obstruction.Methods The clinical data of 72 colon cancer patients with intestinal obstruction was collected and analyzed.The patients were divided into two groups:traditional group(36 cases)and FTS group(36 cases)by random number table method.The postoperative VAS score,first time out of bed,first exhaust time,first defecation time,first time,eating time and postoperative complications in hospital was collected and analyzed.Results The VAS score of FTS group was significantly lower than that in the traditional group at the 1 st and 3 rd day after operation(P<0.05),but there was no significant difference between the two groups on the 7 th day after operation(P>0.05).The first time out of bed in FTS group and traditional group was(17.66±12.10)h and(26.37±10.70)h,respectively;the first exhaust time was(47.54±15.30)h and(57.95±18.40)h,respectively;the first defecation time was( 98. 26 ± 27. 10) h and( 115. 63 ± 27. 50) h,respectively;the first inlet time was( 48. 72 ± 13. 50) h and( 57. 75 ± 17. 00) h,respectively;the discharging time was( 5. 85 ± 2. 2) d and( 8. 73 ± 3. 5) d,respectively. The difference between the two groups was statistically significant( P <0. 05). The incidence of postoperative pulmonary infection and incision infection in group FTS was less than that in traditional group( P < 0. 05). Postoperative abdominal distention and vomiting in group FTS were significantly higher than those in traditional group( P < 0. 05). There was no significant difference in postoperative complications such as intraperitoneal hemorrhage,intraperitoneal infection and anastomotic stenosis between the two groups( P > 0. 05). Conclusion FTS is a safe and effective method in colon cancer patients complicated with intestinal obstruction,and does not increase the risk of complications,which accelerates the postoperative rehabilitation and shortening hospital stays.

关 键 词：快速康复外科理念 结肠癌 肠梗阻 

分 类 号：R735.35[医药卫生—肿瘤]