作者：陈声飞1，阙剑锋1，黄嘉俊1，刘跃强1，倪新建1，胡斌1

单位：1. 惠州市中心人民医院博罗分院 普通外科，广东 博罗 516100

Authors:  CHEN Shengfei1, QUE Jianfeng1, HUANG Jiajun1, LIU Yueqiang1, NI Xinjian1, HU Bin1

Unit:  Department of General Surgery, Boluo county People's Hospital, Boluo 516100, Guangdong, China

摘要：

目的  探讨加速康复外科联合肠内营养技术在老年腔镜胃癌根治术围手术期的应用价值。方法  选取从2014年1月至2019年2月我院101例老年胃癌手术患者作为研究对象,根据围手术期处理措施的不同分为两组,采用加速康复外科联合肠内营养措施的56例患者为试验组,采用传统围手术期处理方案的45例纳入对照组。观察两组患者术后首次肛门排气时间、首次排便时间、疼痛评分、平均静脉输液时间、术后住院时间、住院费用、术后并发症的情况、血清白蛋白水平变化。结果  与对照组相比,试验组首次肛门排气时间[(54.53±2.39) h vs.(76.25±9.52) h, P=0.022]、首次排便时间[(77.23±3.76) h vs.(98.38±6.75) h, P=0.016]、疼痛评分[(4.17±0.87)分vs.(7.25±1.37)分, P=0.007]、平均静脉输液时间[(5.36±1.56) d vs.(9.18±3.66) d, P=0.016]、术后住院时间[(6.87±1.36) d vs.(10.43±2.36) d, P=0.005]均缩短; 住院费用减少[(41278.5±1256.3)元vs.(45267.6±2452.4)元, P=0.001]; 术后并发症发生率降低[14.28%vs. 37.77%, P=0.008]。术后第3天和第5天试验组患者的白蛋白水平高于对照组(均P<0.05)。结论  加速康复外科在老年腔镜胃癌根治术中应用是安全有效的,并且能够加速患者康复;肠内营养技术能够帮助加速康复外科的实施。

关键词： 加速康复外科; 肠内营养; 胃癌; 根治术

Abstract：

Objective  To explore the clinical efficiency of enhanced recovery after surgery combine enteral nutrition in eldly gastric cancer surgery. Methods  From January 2014 to February 2019, 101 patients with gastric cancer in our hospital were divided into two groups according to different perioperative management, 56 patients who had used enhanced recovery after surgery combine enteral nutrition in perioperative period were as experimental group. Other 45 patients who had used traditional protocol were as control group. We observed the postoperative time of the first anal exhaust, the first defecation time, pain scores, average venous transfusion time, postoperative length of stay, hospitalization expenses, postoperative complications, serum albumin change. Results  In experimental group, the first anal exhaust time [(54.53±2.39) h vs. (76.25±9.52) h, P=0.022], the first defecation time [(77.23±3.76) h vs. (98.38±6.75) h, P=0.016], pain scores[(4.17±0.87) score vs. (7.25±1.37) score, P=0.007], average venous transfusion time [(5.36±1.56) d vs. (9.18±3.66) d, P=0.016], postoperative length of stay[(6.87±1.36) d vs. (10.43±2.36) d, P=0.005] were shorter than those in control group. The hospitalization expenses [(41278.5±1256.3) Yuan vs. (45267.6±2452.4) Yuan, P=0.001], the incidence of postoperative complications [14.28% vs. 37.77%, P=0.008], the levels of serum albumin in the experimental group were higher than those in the control group (P<0.05). Conclusions  Enhanced recovery after surgery is safe and effective in promoting the post-operative recovery of eldly gastric cancer surgery. Enteral nutrition can guarantee the implementation of enhanced recovery after surgery.

Key Words:  Enhanced recovery after surgery; Enteral nutrition; Gastric cancer; Radical operation