快速康复在不同方式胃癌根治手术中的应用

目的:评价快速康复(fast track,FT)模式在不同方式胃癌根治手术患者术后康复中的有效性及安全性。方法:收集我科2016年1月至2017年6月期间行开放(OS)及腹腔镜(LS)胃癌根治手术患者各40例,随机分为FT处理组(OS+FT组、LS+FT组)和常规处理(NT)对照组(OS+NT组、LS+NT组),比较不同处理模式对术后疼痛评分、恢复情况和术后并发症发生率的影响。结果:OS+FT组、LS+FT组术后1、2、3、4和5 d疼痛评分均低于NT对照组,各观察时点差异均有统计学意义(P <0. 005); OS+FT组、LS+FT组术后首次排气时间、首次离床时间以及住院时间均短于NT对照组(P <0. 05);术后OS+FT组、LS+FT组总体并发症发生率均为10%,与NT对照组(OS+NT组20%,LS+NT组15%)相比,差异无统计学意义(P> 0. 05)。结论:FT模式有利于减少患者痛苦,加速术后恢复,未增加术后并发症风险,在不同方式胃切除手术患者围术期处理过程中安全、有效。

Application of fast track surgery for patients undergoing different types of gastrectomy

Objective:To evaluate the effectiveness and safety of fast track (FT) model in the postoperative rehabilitation of patients with different types of gastrectomy.Methods:Patients with gastric cancer who underwent open surgery (OS) (n=40) or laparoscopic surgery (LS) (n=40) in our hospital from January 2016 to June 2017 were enrolled in this study.Patients were randomly divided into FT treatment groups (OS+FT group,n=20.LS+FT group,n=20) and normal track (NT) control groups (OS+NT group,n=20.LS+NT group,n=20).The pain score,postoperative rehabilitation data and incidence of postoperative complications were collected and analyzed.Results:Compared with patients treated with NT,the pain scores were significantly lower in patients treated with FT at 1,2,3,4 and 5 d post-OS or post-LS (P＜0.005).Time to first flatus,time to ambulation and postoperative hospital stay were significantly shorter in OS+FT group and LS+FT group (P＜0.05).Postoperative complication rate in OS+FT group and LS+FT group was 10%,and there was no significant difference compare with OS+NT group and LS+NT group (10% vs 20% and 10% vs 15%,respectively) (P＞0.05).Conclusion:FT can significantly ameliorate the postoperative pain and is beneficial to rehabilitation,while it does not increase the risk of postoperative complications.FT is safe and effective forpatients undergoing open gastrectomy or laparoscopic gastrectomy.