加速康复外科联合关闭盆底腹膜在机器人直肠癌手术中的短期临床疗效  

Short-term outcomes of enhanced recovery after surgery combined with pelvic peritoneum closure in robot-assisted surgery for rectal cancer

作　　者：段耀星[1] 王赫 王玲[3] 李来元 燕东[1] 杨芳花 杨熊飞[1] 张维胜[1] 杜斌斌[1] DUAN Yaoxing;WANG He;WANG Ling;LI Laiyuan;YAN Dong;YANG Fanghua;YANG Xiongfei;ZHANG Weisheng;DU Binbin(Department of Colorectal Surgery,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Clinical Medicine,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China;Department of Pathology,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Internal Medicine,First People’s Hospital of Longxi,Dingxi 748100,China)

机构地区：[1]甘肃省人民医院肛肠科,甘肃兰州730000 [2]甘肃中医药大学临床医学院,甘肃兰州730000 [3]甘肃省人民医院病理科,甘肃兰州730000 [4]定西市陇西县第一人民医院内一科,甘肃定西748100

出　　处：《机器人外科学杂志（中英文）》2021年第1期38-45,共8页Chinese Journal of Robotic Surgery

基　　金：甘肃省自然科学基金(18JR3RA055);甘肃省卫健委项目(GSWSKY-2019-69);甘肃省人民医院科研基金(20GSSY3-1,20GSSY4-9)。

摘　　要：目的:探讨加速康复外科(Enhanced recovery after surgery,ERAS)联合关闭盆底腹膜在机器人直肠癌手术中的应用和短期临床疗效。方法:回顾性分析2018年10月~2019年10月甘肃省人民医院肛肠科确诊为直肠癌并行机器人全直肠系膜切除术患者的人口学资料和临床资料。根据纳入标准共收集135例符合此研究的患者,其中研究组为行ERAS联合术中关闭盆底腹膜术患者(65例),对照组为行常规措施和未关闭盆底腹膜术患者(70例),两组患者均行机器人直肠癌切除术。比较两组患者术前、术中和术后情况。结果:两组患者均顺利完成手术。与对照组相比,研究组术后首次排气时间、进食流质时间、留置引流管时间、首次下床时间和住院时间均短于对照组(P<0.05);研究组疼痛程度较轻(P<0.05);研究组术前血糖维持效果较好(P<0.05);两组患者术后第1d和第3d炎性指标均较术前水平明显升高,但与研究组相比,术后第1d和第3d对照组IL-6和PCT、WBC升高更为明显(P<0.05)。两组患者术后引流量、并发症发生率和病理学结果比较,差异均无统计学意义(P>0.05)。结论:ERAS联合关闭盆底腹膜应用于机器人直肠癌手术可减轻术后疼痛,促进早期胃肠道功能快速恢复,减轻应激反应,安全有效,值得临床推广。Objective:To investigate the application and short-term clinical effect of enhanced recovery after surgery(ERAS)combined with pelvic peritoneum closure in robot-assisted surgery for rectal cancer.Methods:The demographic and clinical data of patients with rectal cancer underwent robotic total mesorectal excision in the Department of Anorectal of Gansu Provincial People’s Hospital from October 2018 to October 2019 were retrospectively analysed.According to the inclusion criteria,a total of 135 patients were eligible for this study.The study group consisted of 65 patients with pelvic peritoneum closed during ERAS.The control group was given routine care measures and 70 patients with pelvic floor peritoneum closure included.Rectal cancer resection.The conditions of the two groups were compared before,during and after surgery.Results:All the operations were successfully completed.Compared with the control group,the study group had shorter postoperative flatus time,postoperative fluid diet time,drainage time,activity time and hospitalization time than the control group(P<0.05).The pain degree in the study group was less severe and the number of analgesics using was less than that in the control group(P<0.05).The blood glucose maintenance effect of the study group was better before operation(P<0.05).The inflammatory indexes of the two groups on the first and third days after operation were significantly higher than those before operation.Compared with the study group,the levels of IL-6,PCT and WBC in the control group were significantly higher on the first and third days after operation(P<0.05).There was no significant difference in postoperative drainage volume,complication rate and pathological results between the two groups(P>0.05).Conclusion:The application of ERAS combined pelvic peritoneum closure in robotassisted rectal cancer surgery can reduce postoperative pain,promote recovery of gastrointestinal function and relieve stress response.It is safe and effective,which is worthy of clinical promotion.

关 键 词：直肠癌 机器人手术 加速康复外科 关闭盆底腹膜 短期疗效 

分 类 号：R735.37[医药卫生—肿瘤]