作者：李庆贤, 方妙婵, 李丽华, 袁锡裕, 丁伟杰

单位：东莞市人民医院 胃肠外科，广东 东莞 523000

Authors: Li Qingxian, Fang Miaochan, Li Lihua, Yuan Xiyu, Ding Weijie

Unit:  Department of Gastrointestinal Surgery, Dongguan People's Hospital, Dongguan 523000, Guangdong, China

摘要：

目的  探讨加速康复外科理念对腹腔镜胃癌D2根治术后炎症反应及并发症的影响。方法  选取2021年11月至2023年8月东莞市人民医院胃肠外科同一医疗组行腹腔镜胃癌D2根治术的60例患者，前瞻性非随机将患者分为两组，加速康复外科（enhanced recovery after surgery, ERAS）组30例，传统组30例，观察两组患者的术后第1 天、第3 天、第6 天的炎症反应指标[白细胞(white blood cell, WBC)、C反应蛋白(C-reactive protein , CRP)、降钙素原(procalcitonin, PCT)]、数字疼痛评分表(numeric rating scale，NRS)评分、术后并发症发生率等情况。结果  术后第1天，ERAS 组与传统组相比, WBC变化无明显差异, 而ERAS组CRP、PCT水平较低（P<0.05）。术后第3天、第6天, ERAS组的CRP、WBC、PCT水平均比同时间的传统组低，差异有统计学意义(P<0.05）。ERAS组术后12 h、24 h、48 h NRS 评分均比同时间的传统组低(P<0.05)。ERAS组发生并发症3例（10.0%），传统组发生并发症4例（13.3%），无死亡病例，两组Ⅲ级或以上并发症及总并发症发生率比较，差异无统计学意义(P＞0.05)。结论  腹腔镜胃癌D2根治术后应用ERAS理念，可以明显减轻患者的炎症反应，促进胃肠道功能恢复，不增加术后并发症的发生率，疗效显著。

关键词： 加速康复；腹腔镜胃癌D2根治术；炎症反应；并发症

Abstract：

Objective  To investigate the effect of fast recovery surgery concept on inflammatory response and complications after laparoscopic D2 radical gastrectomy for gastric cancer. Method This study selected 60 patients from the same medical group in the Gastrointestinal Department of Dongguan People's Hospital who underwent laparoscopic D2 radical gastrectomy for gastric cancer from November 2021 to August 2023, and patients were prospectively and non -randomly divide into two groups: the enhanced recovery after surgery (ERAS) group with 30 cases and the traditional group with 30 cases. The inflammatory response indexes [C-reactive protein (CRP), white blood cell (WBC), procalcitonin (PCT)], numeric rating scale (NRS) pain score, and postoperative complication rates were observed on the 1st, 3rd, and 6th days after the operation of the two groups. Result  On the 1st day after surgery, there was no significant difference in WBC change between the ERAS group and the traditional group, but the levels of CRP and PCT in the ERAS group were lower (P<0.05). On the 3rd and 6th day after surgery, the levels of CRP, WBC and PCT in the ERAS group were all lower than those in the traditional group during the same period, and the differences were statistically significant (P<0.05). The postoperative NRS scores of the ERAS group at 12 hours, 24 hours, and 48 hours were lower than those of the traditional group during the same period (P<0.05). There were 3 cases (10.0%) of complications in the ERAS group and 4 cases (13.3%) in the traditional group, and there were no deaths. There were no statistically differences in the incidence of grade III or above complications and overall complications between the two groups (P>0.05). Conclusion  The application of fast recovery surgery concept after laparoscopic D2 radical resection of gastric cancer can significantly reduce the inflammatory response of patients, promote the recovery of gastrointestinal function, and not increase the incidence of postoperative complications. The therapeutic effect is significant and worth promoting.

Key Words:  Enhanced recovery after surgery; Laparoscopic D2 radical gastrectomy; Inflammatory response; Complications