加速康复外科在3D腹腔镜辅助胃癌根治术中的应用研究  

The role of enhanced recovery after surgery in three dimensional laparoscopy-assisted radical gastrectomy for gastric cancer

作　　者：杨吉荣[1] 张珂诚 崔建新[2] 卢灿荣[2] 卫勃[2] 唐云[2] 陈凛[2] YANG Ji-rong;ZHANG Ke-cheng;CUI Jian-xin(Unit 1 of Department of General Surgery,Anyang District Hospital in Puyang,Puyang 455000,China;Department of General Surgery,Chinese PLA General Hospital)

机构地区：[1]濮阳市安阳地区医院普外一科,河南濮阳455000 [2]解放军总医院普通外科

出　　处：《腹腔镜外科杂志》2020年第3期209-213,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨加速康复外科(ERAS)在3D腹腔镜辅助胃癌根治术中的安全性与可行性。方法:收集2018年1月至6月在ERAS路径下行3D腹腔镜辅助胃癌根治术患者的临床资料。计算患者ERAS路径的依从性。采用单因素与多因素分析患者延迟出院的影响因素。结果:共纳入84例行3D腹腔镜辅助胃癌根治术的患者。8例(9.5%)术后发生Clavien-DindoⅡ级以上并发症,术后无一例死亡。ERAS路径的依从性为0.69(IQR:0.50~0.88)。单因素回归分析结果显示,手术时间、出血量及ERAS路径的依从性为患者延迟出院的影响因素(P<0.05),但多因素回归分析结果表明,仅ERAS路径为患者延迟出院的独立影响因子(P=0.001)。ERAS路径依从性与术后住院时间显著负相关(Spearman r=-0.7,P<0.001)。高ERAS依从性患者住院费用更低(P=0.031)。结论:采用ERAS路径行3D腹腔镜胃癌根治术是安全、可行的。高ERAS依从性可促进患者康复,缩短住院时间,减少住院费用。Objective:To investigate the safety and feasibility of enhanced recovery after surgery in 3D laparoscopy-assisted radical gastrectomy for gastric cancer.Methods:Patients’demographics and perioperative outcomes were collected who received 3D laparoscopy-assisted radical gastrectomy for gastric cancer between Jan.2018 and Jun.2018.ERAS protocol compliance rates were assessed.Univariate and multivariate logistic regression analysis was performed to investigate influential factor for delayed discharge.Results:A total of 84 patients receiving 3D laparoscopy-assisted radical gastrectomy for gastric cancer in ERAS settings were included in the final analysis.Eight patients(9.5%)had postoperative complications≥gradingⅡand mortality rate was 0%.The ERAS protocol compliance rate was 0.69(IQR:0.50-0.88).Univariate regression analysis revealed operation time,blood loss and ERAS protocol compliance were significantly associated with delayed discharge(P<0.05),while multivariate analysis showed only ERAS protocol compliance was statistically significant(P=0.001).Correlation analysis also demonstrated that the postoperative hospital stay was negatively correlated with the ERAS compliance(Spearman r=-0.7,P<0.001).Patients with high compliance rates had significantly less hospitalization cost(P=0.031).Conclusions:ERAS protocol is safe and feasible for patients receiving 3D laparoscopic radical gastrectomy.High ERAS compliance accelerates recovery,facilitates early discharge and saves cost.

关 键 词：胃肿瘤 胃癌根治术 腹腔镜检查 加速康复外科 成像 三维 

分 类 号：R735.2[医药卫生—肿瘤]