加速康复外科在达芬奇机器人胃癌根治术中的应用体会

目的:探讨快速康复外科(FTS)在达芬奇机器人胃癌根治术中的临床应用价值。方法:选取2018年10月至2019年5月53例行达芬奇胃癌根治术的患者,随机分为快速康复组(n=25)与常规组(n=28),快速康复组采取FTS理念指导下的围手术期管理;常规组采取常规围手术期管理。比较两组临床资料、围手术期资料(术后住院时间、C反应蛋白、术后下床活动时间、术后进食流食时间、术后通气时间、清扫淋巴结数量、术中出血量、住院费用)及并发症情况。结果:快速康复组与常规组术后通气时间(2.16±0.62)d vs.(2.71±0.46)d]、术后进食流食时间(2.28±0.68)d vs.(3.07±0.47)d]、术后C反应蛋白(16.54±2.68)mg/dL vs.(18.47±2.99)mg/dL]、术后下床活动时间(1.20±0.41)d vs.(2.86±0.76)d]、术后住院时间(9.32±1.73)d vs.(12.57±7.90)d]差异均有统计学意义(P<0.05),两组住院总费用(89006.59±9202.19)元vs.(90951.84±11549.55)元]、术中出血量(153.20±107.46)mL vs.(157.14±113.62)mL]、清扫淋巴结总数(43.24±18.70)vs.(39.54±12.24)]差异无统计学意义(P>0.05)。结论:FTS与达芬奇机器人胃癌根治术的结合可降低临床分期Ⅲ期及以下无远处转移的原发性胃癌患者的手术应激及炎症反应,促进胃肠功能早期恢复,住院时间短,患者短期收益大,值得进一步临床应用。

Application of fast track surgery in Da Vinci robot radical gastric cancer surgery

Objective:To explore the clinical application value of fast track surgery(FTS)in Da Vinci robot radical gastrectomy for gastric cancer.Methods:Fifty-three patients with gastric cancer who underwent Da Vinci radical gastrectomy of from Oct.2018 to May 2019 were selected as the research objects,and the patients were randomly divided into FTS group(25 cases)and conventional group(28 cases),which adopted perioperative management under the guidance of FTS or routine perioperative management,respectively.The general data,perioperative data(postoperative hospital stay,C-reactive protein,postoperative ambulation time,postoperative liquid food intake time,postoperative ventilation time,the number of lymph node dissection,intraoperative blood loss,hospitalization expenses)and complications were compared between the two groups.Results:The FTS group and conventional group were statistically significantly different in postoperative ventilation time(2.16±0.62)d vs.(2.71±0.46)d],postoperative liquid food intake time(2.28±0.68)d vs.(3.07±0.47)d],postoperative C-reactive protein(16.54±2.68)mg/dL vs.(18.47±2.99)mg/dL],postoperative ambulation time(1.20±0.41)d vs.(2.86±0.76)d]and postoperative hospital stay(9.32±1.73)d vs.(12.57±7.90)d].However,there was no significant difference in the total cost of hospitalization(89006.59±9202.19)yuan vs.(90951.84±11549.55)yuan],intraoperative blood loss(153.20±107.46)mL vs.(157.14±113.62)mL],total number of lymph nodes removed(43.24±18.70)vs.(39.54±12.24)]between the two groups(P>0.05).Conclusions:The combination of FTS and Da Vinci robotic radical gastrectomy can reduce the surgical stress and inflammation in primary gastric cancer patients without distant metastasis at clinical stage Ⅲ or below,promote the early recovery of gastrointestinal function,shorten the hospital stay,and increase the short-term benefits of patients,this combination is worthy of further clinical application.