加速康复外科在腹腔镜结直肠癌手术中的应用及对免疫功能的影响  

Application of enhanced recovery after surgery in laparoscopic resection of colorectal cancer and its influence on immune function

作　　者：李靖 陈建军[1] 应隽[2] 姜建平 骆洋[1] 俞旻皓[1] 钟鸣[1] LI Jing;CHEN Jian-jun;YING Juan(Department of Gastrointestinal Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Anesthesiology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127 [2]上海交通大学医学院附属仁济医院麻醉科 [3]上海交通大学医学院附属仁济医院手麻科

出　　处：《腹腔镜外科杂志》2020年第11期853-858,共6页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金项目(81672347);国家自然科学基金项目(81802308);上海市科学技术委员会医学引导类项目(19411966200)。

摘　　要：目的:探讨加速康复外科(ERAS)策略在腹腔镜结直肠癌手术中的应用效果及对患者机体免疫功能的影响。方法:采用回顾性队列研究方法,收集2017年6月至2019年6月手术治疗的206例结直肠癌患者的临床资料,根据是否行ERAS分为ERAS组(n=101)与非ERAS组(n=105)。观察两组术中情况、术后恢复情况、术后全身营养与免疫系统恢复情况、术后并发症及出院后30 d内非计划再入院率,采用门诊与电话方式进行随访,了解患者术后恢复及术后并发症情况。结果:两组手术时间、术中出血量差异无统计学意义(P>0.05)。ERAS组首次排气时间[(38.14±1.11)h vs.(56.80±1.39)h]、首次排便时间[(3.06±0.10)d vs.(3.91±0.09)d]、术后住院时间[(6.26±0.26)d vs.(8.54±0.28)d]短于非ERAS组,差异有统计学意义(P<0.01)。相对非ERAS组,ERAS组术后C反应蛋白较快恢复至术前水平(P<0.001),两组白蛋白、血红蛋白及术后3个月生活质量评分差异无统计学意义(P>0.05)。ERAS组CD3+、CD4+、CD8+于术后第1天降至最低,术后第3天、第5天逐渐回升;非ERAS组术后第1天、第3天差异无统计学意义,术后第5天开始逐渐回升。ERAS组术后共发生并发症9例(8.91%),非ERAS组发生14例(13.33%),差异无统计学意义(P>0.05)。出院后30 d,ERAS组共3例非计划再入院,非ERAS组共2例,两组差异无统计学意义(P>0.05)。结论:ERAS在不增加腹腔镜结直肠手术患者围手术期并发症的同时利于术后早期康复,可加快恢复术后营养状态及免疫功能,值得临床推广。Objective:To explore the effect of enhanced recovery after surgery(ERAS)strategy in laparoscopic resection of colorectal cancer and its impact on immune function of patients.Methods:A retrospective cohort study was conducted to collect clinical data of 206 patients with colorectal cancer who underwent laparoscopic surgery from Jun.2017 to Jun.2019.According to whether ERAS was performed,the patients were divided into ERAS group(n=101)and non-ERAS group(n=105).Observation Indicators included intraoperative situation and postoperative recovery,postoperative general nutrition and immune system recovery,postoperative complications and unplanned readmission rate within 30 d after discharge.Patients were followed up by outpatient and telephone to understand the postoperative recovery and complications.Results:There was no significant difference between ERAS group and non-ERAS group in terms of operation time and intraoperative bleeding volume(P>0.05).The first exhaust time[(38.14±1.11)h vs.(56.80±1.39)h],the first defecation time[(3.06±0.10)d vs.(3.91±0.09)d]and the postoperative hospital stay[(6.26±0.26)d vs.(8.54±0.28)d]in ERAS group were significantly shorter than those in non-ERAS group(P<0.01).Compared with non-ERAS group,the C-reactive protein of ERAS group recovered to the preoperative level more quickly(P<0.001),while there was no significant difference in albumin,hemoglobin and quality of life scores after 3 months(P>0.05).CD3+,CD4+and CD8+in ERAS group decreased to the lowest level on the first day after operation,and gradually increased on the third and fifth day after operation.There was no significant difference between the first day and the third day after operation in non-ERAS group,but those indicators gradually increased on the fifth day after operation.The total number of complications in ERAS group was 9(8.91%)and that in non-ERAS group was 14(13.33%),there was no significant difference(P>0.05).There were 3 cases in ERAS group and 2 cases in non-ERAS group of 30 d unplanned readmission,with no

关 键 词：结直肠肿瘤 腹腔镜检查 加速康复外科 免疫 

分 类 号：R735.3+4[医药卫生—肿瘤]