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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 283 -286. doi: 10.3877/cma.j.issn.1674-3946.2021.03.014

所属专题： 文献；

论著

快速康复外科理念在中间入路腹腔镜结肠癌根治术中的应用价值
邹燕慧1, 王猛1, 叶峰2, 方美娟1,†()   
  1. 1. 363000　联勤保障部队第909医院普通外科
    2. 361003　厦门大学附属第一医院普外科
  • 收稿日期:2021-02-01 出版日期:2021-06-26
  • 通信作者: 方美娟

Application value of fast track surgery in middle approach laparoscopic radical resection of colon cancer

Yanhui Zou1, Meng Wang1, Feng Ye2, Meijuan Fang1,†()   

  1. 1. Department of general surgery, 909 Hospital of joint logistics force (Southeast Hospital Affiliated to Xiamen University) Fujian Province 363000
    2. Department of general surgery, First Affiliated Hospital of Xiamen University Fujian Province 361003
  • Received:2021-02-01 Published:2021-06-26
  • Corresponding author: Meijuan Fang
  • Supported by:
    Science and technology project plan of Fujian Province in 2020(2020J011238)
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邹燕慧, 王猛, 叶峰, 方美娟. 快速康复外科理念在中间入路腹腔镜结肠癌根治术中的应用价值[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 283-286.

Yanhui Zou, Meng Wang, Feng Ye, Meijuan Fang. Application value of fast track surgery in middle approach laparoscopic radical resection of colon cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(03): 283-286.

目的

分析快速康复外科(FTS)理念在中间入路腹腔镜结肠癌根治术中的应用价值。

方法

选取2017年8月至2020年8月手术治疗的100例结肠癌患者，随机分为FTS组、对照组，各50例，使用SPSS 22.0软件进行数据分析，术后并发症等计数资料采用2检验，术中术后各项指标、心理状态评分及营养指标等计量资料以(±s)表示，采用独立t检验，满意度调查采用秩和检验。P<0.05认为差异存在统计学意义。

结果

FTS组排气时间、术后住院时间、住院费用、术后并发症发生率均低于对照组(P<0.05)。两组术后1 d白细胞(WBC)均较手术当日清晨升高，总蛋白(TP)、前白蛋白(PA)、白蛋白(ALB)均下降；FTS组术后1 d WBC低于对照组，其TP、PA、ALB高于对照组(P<0.05)。两组术后7 d焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分均较术前1 d升高，FTS组术后7 d SAS评分、SDS评分低于对照组(P<0.05)。FTS组满意率为70.00%，高于对照组的50.00%(P<0.05)。

结论

基于FTS开展围术期干预能够促进结肠癌患者腹腔镜根治术后早期恢复、降低并发症发生风险，并减轻手术所致机体、心理应激，提高患者满意度。

关键词: 结肠肿瘤, 腹腔镜, 快速康复外科, 中间入路, 治疗结果
Objective

To analyze the application value of fast track surgery (FTS) in middle approach laparoscopic radical resection of colon cancer.

Methods

A total of 100 cases of colon cancer undergoing surgical treatment from August 2017 to August 2020 were randomly divided into FTS group and control group, 50 cases in each. SPSS 22.0 software was used for data analysis. The postoperative complications were counted by χ2 test. The intraoperative and postoperative indicators, psychological state score and nutritional indicators were expressed by (±s). The independent t test was used. The satisfaction survey was conducted by rank sum test. P<0.05 was considered statistically significant.

Results

The exhaust time, postoperative hospital stay, hospitalization cost and incidence of postoperative complications in FTS group were lower than those in control group (P<0.05). On day 1 after operation, white blood cells(WBC) were increased, while total protein (TP), pre-albumin (PA) and albumin (ALB) were decreased in both groups. The WBC of FTS group on day 1 after surgery was lower than that of control group, and the TP, PA and ALB of FTS group were higher than those of control group (P<0.05). The scores of SAS and SDS of both groups on postoperative 7 d were higher than those on preoperative 1 d, and the SAS and SDS scores of FTS group on postoperative 7 d were lower than those of the control group (P<0.05). The satisfaction rate of FTS group was 70.00%, which was higher than 50.00% of the control group (P<0.05).

Conclusion

The perioperative intervention based on FTS can promote the early recovery, reduce the risk of complications, and reduce the physical and psychological stress caused by surgery, and improve patient satisfaction.

Key words: Colonic neoplasms, Laparoscopes, Fast track surgery, Intermediate approach, Treatment outcome
表1 100例结肠癌患者不同围术期处理方法两组一般临床资料比较[(±s)，例]
组别 例数 年龄(岁) 性别(男/女) BMI(kg/m2) TNM(Ⅰ/Ⅱ/Ⅲ)
FTS组 50 55.7±10.3 31/19 22.7±1.8 4/16/30
对照组 50 56.1±11.0 28/22 22.8±1.7 6/13/31
t/χ2值   0.206 0.372 0.352 0.444/0.437/0.042
P值   0.837 0.542 0.726 0.505/0.509/0.838
表2 100例结肠癌患者不同围术期处理方法两组患者恢复情况比较(±s)
组别 例数 排气时间(h) 术后住院时间(d) 住院费用(万元)
FTS组 50 29.2±6.1 7.4±1.3 3.7±0.6
对照组 50 43.0±7.7 11.4±1.6 4.4±0.8
t值   9.907 13.565 5.412
P值   0.000 0.000 0.000
表3 100例结肠癌患者不同围术期处理方法两组患者并发症发生情况比较(例)
组别 例数 肺部感染 切口感染 尿路感染 吻合口漏 其他 合计
FTS组 50 2 1 0 0 1 4
对照组 50 5 2 2 1 2 12
χ2值             4.762
P值             0.029
表4 100例结肠癌患者不同围术期处理方法两组患者实验室指标变化比较(±s)
组别 例数 时间 WBC(g/L) TP(g/L) PA(g/L) ALB(g/L)
FTS组 50 手术当日 6.0±1.2 70.2±5.2 219.4±25.6 41.1±3.4
    术后1 d 10.6±1.6a 62.2±2.7a 172.3±24.3a 36.1±2.4a
对照组 50 手术当日 5.9±1.2 70.3±5.2 218.4±26.1 41.3±3.3
    术后1 d 13.7±1.7ab 46.1±2.8ab 106.6±13.6ab 24.9±2.2ab
表5 100例结肠癌患者不同围术期处理方法两组患者术前术后心理状态变化比较[(±s)，分]
组别 例数 时期 SAS评分 SDS评分
FTS组 50 术前1 d 44.6±5.7 47.2±5.9
    术后7 d 57.3±7.0a 57.1±4.7a
对照组 50 术前1 d 44.4±5.9 47.2±6.0
    术后7 d 69.5±8.7ab 63.9±9.1ab
表6 00例结肠癌患者不同围术期处理方法两组患者满意度评价结果(例)
组别 例数 非常满意 满意 一般 不满意 非常不满意 满意率(%)
FTS组 50 11 24 13 2 0 35(70.0)
对照组 50 4 21 17 7 1 25(50.0)
Uc值             4.167
P值             0.041
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