作者：吴永亮1，刘德伟1，湛文龙1，韦娟丽2，刘伯念1，云文耀1

单位：1.增城区新塘医院（南方医科大学南方医院-新塘医院） 外一科，广东 广州 511340； 2.增城区新塘医院（南方医科大学南方医院-新塘医院） 麻醉科，广东 广州 511340

Authors:  WU Yongliang1, LIU Dewei1, ZHAN Wenlong1, WEI Juanli2, LIU Boniang1, YUN Wenyao1

Unit:  1.Surgical department Ward 1, Xin-Tang hospital, Nan-fang Hospital of Southern Medical University, Guangzhou 511340, Guangdong, China； 2.Department of anesthesiology, Xin-Tang hospital, Nan-fang Hospital of Southern Medical University, Guangzhou 511340, Guangdong, China

摘要：

目的  探讨加速康复外科(Enhanced recovery after surgery, ERAS)理念在基层医院的腹腔镜结直肠癌手术中的应用效果及其安全性。方法  选取2012年1月至2016年12月期间我院行腹腔镜结直肠手术的患者78例,按照围手术期治疗措施的差异分为ERAS组(44例)和传统处理组(34例),观察两组患者的临床疗效、术后恢复情况及术后并发症的情况。结果  ERAS组患者的术后总体住院时间明显少于传统对照组(7.6 vs 9.7天,P<0.05),差异具有统计学意义。与传统处理组相比,ERAS组在术后首次肛门排气时间(1.6 vs 2.2天)、首次排便时间(2.8 vs 3.2天)、下床活动时间(1.2 vs 2.6天)、首次进食固体食物时间(1.3 vs 3.7天)均明显缩短(P<0.05);ERAS组住院总体平均费用亦明显小于对照组(50946.0 vs 56935.0元,P<0.001),术后第1天和第3天疼痛评分亦优于对照组,差异有统计学意义(P<0.05)。ERAS组和传统处理组的总体并发症发生率分别为6.8%和14.7%,差异无统计学意义(P>0.05)。结论  围手术期ERAS理念在基层医院开展腹腔镜结直肠手术中的应用是安全可靠的,具有较强的临床推广价值。

关键词： 结直肠癌; 加速康复外科; 腹腔镜手术; 疗效

Abstract：

Objective  To investigate the clinical effect and safety of enhanced recovery after surgery (ERAS)for laparoscopic colorectal cancer surgery in in grassroots hospital. Methods  78 patients following laparoscopic colorectal cancer surgery between January 2012 and December 2016 in our hospital were retrospectively analyzed. All included patients were divided into two groups according to the perioperative treatment strategy: ERAS group (44 cases) and traditional treatment group (34 cases). Clinical efficiency, postoperative recovery status and postoperative complications were compared between two groups. Results  The average length of postoperative hospital stay in ERAS group (7.6 days) was much shorter (P<0.05) than that in traditional treatment group (9.7 days). Moreover, the mean length of first flatus time (1.6 days), first defecation time (2.8 days), ambulation time (1.2 days), first solid food intake time (1.3 days) in the ERAS group were much shorter than those in the traditional treatment group (P<0.05). The average cost in the ERAS group and the traditional treatment group was 50946 and 56935 yuan, respectively (P<0.05). No significant difference was observed between ERAS group (6.8%) and the traditional treatment group (14.7%) in terms of postoperative complications (P>0.05). Conclusions  Perioperative ERAS combined with laparoscopic surgery for colorectal cancer in local hospital was safe and reliable, which was worthy of clinical popularization.

Key Words:  Colorectal cancer; Enhanced recovery after surgery; Laparoscopy; Treatment effect