快速康复外科理念在结直肠癌患者围手术期中的应用

目的探讨快速康复外科(fast track surgery,FTS)理念在结直肠癌患者围手术期中的应用效果。方法将80例结直肠癌手术患者随机分为观察组和对照组各40例。对照组采取常规护理和指导,观察组实施FTS新理念治疗。比较两组患者术后住院天数、首次肛门排气时间、输液治疗时间、并发症发生率、体重的变化、住院总费用以及患者满意度。结果观察组患者满意度高于对照组;术后住院天数、静脉输液时间短于对照组;首次肛门排气时间早于对照组;体重下降、住院总费用低于对照组,两组比较,均P0.05,差异具有统计学意义。两组患者术后并发症发生率比较,P0.05,差异无统计学意义。结论FTS理念可以有效促进结直肠癌患者术后胃肠道功能的恢复,节省住院总费用,提高患者对护理工作的满意度。     

快速康复外科在腹腔镜结直肠癌根治术围手术期应用疗效的荟萃分析

目的:荟萃分析快速康复外科(FTS)在腹腔镜结直肠癌根治术中的应用疗效。方法:检索Pubmed、EMBASE、Cochrane Library、中国知网、万方数据库和维普数据库发表的FTS在腹腔镜结直肠癌根治术中疗效的文献,采用RevMan5.0软件进行统计分析。结果:9篇文献纳入分析,共纳入患者925例,试验组481例,对照组444例。FTS能缩短术后住院时间,加权均数差为-2.50(95%CI:-4.13,-0.87),P<0.0001;减少术后并发症,相对危险度(RR)为0.61(95%CI:0.47,0.78),P<0.0001;能缩短肠蠕动恢复时间(P<0.01);但在30d内再次入院率无统计学意义,RR为1.33(95%CI:0.78,2.25),P=0.29。结论:FTS在腹腔镜结直肠癌根治术中能降低术后并发症,缩短术后住院时间,有利于患者康复。     

快速康复外科理念结合腹腔镜治疗结直肠疾病的效果观察

选择2014年10月~2016年5月我院收治的178例结直肠疾病患者作为此次研究对象,把全部患者随机分为对照组与观察组各89例,对照组实施传统开腹手术治疗并辅以围术期常规干预,观察组应用腹腔镜治疗并辅以围术期快速康复外科理念干预。观察组患者的首次排气时间、C反应蛋白水平以及住院时间均要显著优于对照组(P0.05);观察组并发症发生率是13.4%,对照组并发症发生率是41.6%,组间并发症发生情况对比具有显著性差异(P0.05)。在结直肠疾病患者治疗中应用快速康复外科理念结合腹腔镜治疗具有显著效果,能够明显加快患者康复,减少并发症,值得临床推广应用。     

快速康复外科护理在腹腔镜结直肠癌患者围手术期的应用

目的 探讨快速康复外科护理在腹腔镜结直肠癌患者围手术期中应用的效果.方法 将60例行腹腔镜结直肠癌手术的患者随机分为对照组与观察组各30例.对照组患者给予常规护理,观察组患者接受快速康复外科护理,比较2组手术情况、临床效果及术后并发症发生率.结果 2组麻醉时间、手术时间及术中出血量比较无显著差异;观察组患者术后下床时间、排气时问、住院时间显著少于对照组;观察组与对照组术后并发症发生率分别为26.7％和46.7％,差异显著.结论 对腹腔镜结直肠癌围手术期患者实施快速康复外科护理,可促进患者更快地康复,减少住院时间和术后并发症.     

快速康复外科理念在腹腔镜结直肠手术患者中的应用

目的探讨快速康复外科(FTS)理念在腹腔镜结直肠癌手术患者中的应用效果。方法将收治的64例腹腔镜下行结直肠癌根治术患者分为FTS组和对照组,每组32例。观察两组患者术后下床时间、住院时间、首次肛门排气时间、首次排便时间、住院患者满意度及术后并发症发生情况。结果与对照组相比,FTS组患者术后住院时间缩短,首次肛门排气、排便时间、住院时间及下床时间均显著提前,差异有统计学意义(P0.05)。FTS组术后并发症发生率均低于对照组,但差异无统计学意义(P0.05)。结论快速康复外科理念可以促进患者康复,缩短住院时间,减少术后并发症的发生,值得在临床上推广应用。     

腹腔镜结直肠肿瘤手术快速康复的护理

腹腔镜作为当今最常用的微创技术,在结直肠癌手术中的应用日益增多,其可以缩短患者的住院时间、减轻术后疼痛、减少肺部并发症的发生并促进患者早日康复.虽然快速康复外科(fast track surgery,FTS)是指采用一系列有循证医学证据的围手术期处理的优化措施,减少手术病人生理和心理的创伤应激,其核心是减少病人的创伤和应激损害.它不仅要求手术微创,而且更重视围手术期的其他处理对手术病人康复的影响,以达到病人快速康复的目的.目前,加速康复外科应用于临床最为成功的领域是结肠切除,并且病人的免疫功能、营养状态和器官功能等都可获得改善[1-2].但其需要不同学科的专业的人员组织在一起进行协作,其中护理在康复中起到积极作用.现总结如下.     

快速康复外科方案对腹腔镜结直肠癌手术患者预后及炎症反应的影响

目的 探讨快速康复外科(ERAS)方案对腹腔镜结直肠癌手术患者预后及炎症反应的影响.方法 选取80例择期行腹腔镜下结直肠癌切除术的患者作为研究对象,随机分为对照组和研究组,每组40例.对照组按照传统方案实施围术期管理,研究组按照ERAS方案实施围术期管理.比较2组患者术前(T1时点)、术后12 h(T2时点)、术后24 h(T3时点)和术后48 h(T4时点)的血清炎症因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10 (IL-10)、肿瘤坏死因子-α(TNF-α)]水平,并比较2组术中出血量、围术期阿片类药物使用剂量、腹腔引流管放置时间和术后排气排便时间、住院时间、视觉模拟评分法(VAS)评分、并发症发生情况.结果 T2、T3、T4时点,2组血清炎症因子水平均高于T1时点,差异有统计学意义(P＜0.05);T1时点,2组血清炎症因子水平差异无统计学意义(P＞0.05);T2、T3、T4时点,研究组血清炎症因子水平均低于对照组,差异有统计学意义(P＜0.05).研究组围术期阿片类药物使用剂量少于对照组,腹腔引流管留置时间、术后住院时间短于对照组,术后VAS评分、并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论 ERAS方案应用于腹腔镜结直肠癌手术患者中能有效降低患者炎症因子水平,减轻疼痛,缩短住院时间,减少术后并发症的发生.     

快速康复外科理念指导下腹腔镜胆道探查术的前瞻性随机对照临床研究

目的 探讨快速康复外科理念指导下腹腔镜胆道探查术的疗效,并分析其安全性.方法 选择2007年8月～2012年2月株洲市一医院肝胆外科择期行腹腔镜胆道探查术的190例患者,按住院号分为快速康复(FTS)组和对照组.快速康复组应用FTS措施进行处理,对照组采取传统的方案治疗,两组行随机对照研究,比较两组术后胰岛素抵抗指数、营养状况、麻醉用药量、术后清醒时间、术后下床活动时间、镇痛效果、住院费用、住院天数、术后并发疰发生率以及患者对治疗的满意度.结果 实验组与对照组比较,患者术后胰岛素抵抗指数降低,术后体重下降程度缩短,麻醉用药量减少,术后清醒时间及肛门排气时间以及术后住院天数显著缩短,住院费用减少,并发症减少,患者满意度提高.结论 快速康复外科理念指导下腹腔镜胆道探查术能明显减少患者痛苦,减少并发症的发生,加速患者术后康复,提高患者满意度,临床应用安全,可行.     

快速康复外科理念在腹腔镜治疗结直肠癌患者围术期的临床应用

目的：探讨快速康复外科理念( fast track surgery,FTS)应用于胃肠外科腹腔镜治疗结直肠癌患者围术期的短期临床效果。方法选取2015年2~12月我院胃肠外科收治的经腹腔镜手术治疗结直肠癌患者共120例,随机分为观察组与对照组,每组60例。其中,对照组患者在围术期接受胃肠外科常规护理,而观察组患者则在此基础上接受基于快速康复外科理念指导的针对性围术期护理。收集两组患者术后进食时间、排气排便时间、下床活动时间及住院天数等数据,并进行对比分析。结果手术时间与术中出血量差异均无统计学意义( P>0.05)。术后指标比较,对照组患者术后首次排气时间、术后首次下床活动时间、拔管时间以及术后住院时间均显著长于观察组(均P<0.01)。但两组并发症发生率差异无统计学意义( P>0.05)。结论在胃肠外科腹腔镜手术结直肠癌患者中应用快速康复外科理念指导,能够促进患者康复,提高患者生活质量,缩短住院时间,节约住院费用,同时安全有效,临床应用价值高。     

快速康复外科在结直肠癌限期手术中应用

目的 探讨对结直肠癌限期手术快速康复患者的有效护理方法.方法 选取行结直肠癌限期手术患者62例,随机分为实验组（n=32）和对照组（n=30）,实验组采用快速康复外科的治疗方法 对照组采用传统的治疗方法.比较两组患者术前感觉、排气、排便及耐受半流时间、腹胀、呕吐及胃管情况、并发症、病死率与再入院率、术后住院时间.结果 两组患者术前口渴、饥饿情况比较差异有统计学意义（P〈0.01）,实验组患者在首次排气时间、首次排便时间、首次耐受半流时间级术后住院时间均比对照组短,术后感染性并发症发生率较对照组明显降低（P〈0.05） 两组患者均未发生吻合口瘘、吻合口出血、腹腔感染等并发症 无一例发生误吸等麻醉并发症.结论 对结直肠癌限期手术应用快速康复可以促进早期肠功能恢复,减轻患者痛苦,减轻并发症的发生,利于患者早期康复,减少住院时间和治疗费用,而护理在快速康复外科中具有重要的作用.     

腹腔镜结直肠癌根治术与传统根治手术临床效果对比研究

[目的]探讨结直肠癌腹腔镜根治术的可行性和安全性.[方法]回顾我院2006年1月至2011年11月成功施行手术治疗的96例结直肠癌患者的临床资料,其中腹腔镜结直肠癌根治手术45例,传统开腹结直肠癌根治手术51例.对比两组患者的手术时间、术中出血量、切除肠管长度、淋巴结获取数和术后胃肠功能恢复时间、术后留院时间以及局部复发、远处转移等指标.[结果]两组患者术前ASA评分、并发症、病理分级差异无统计学意义(P＞0.05).腹腔镜组术中出血量明显少于开腹组[(53.4±19.7) ml vs.(145.0±79.4)ml,P＜0.05],手术时间开腹组明显短于腹腔镜组[(174.2±40)minvs.(245.6±87) min,P＜0.05];与开腹组相比,腹腔镜组术后肛门排气时间[(2.2±0.5)dvs.(3.4±1.0)d,P＜0.05]、进食时间[(4.1±1.1)dvs.(6.1±1.6)d,P＜0.05]及术后留院时间[(11.7±2.3)dvs.(18.8±13.9)d,P＜0.05]显著缩短;手术切除肠管长度、术中淋巴结获取数以及术后相关并发症两组差异无统计学意义(P＞0.05).随访1 ～36个月,平均18个月,两组局部复发和远处转移差异无统计学意义(P＞0.05).[结论]腹腔镜结直肠癌根治术具有良好的安全性及可行性,具有出血少、康复快、住院时间短等优势,可在有一定腹腔镜手术基础的医院实行.     

Current status of randomized controlled trials for laparoscopic gastric surgery for gastric cancer in China

China alone accounts for nearly 42% of all new gastric cancer cases worldwide, and gastric cancer is the third leading cause of cancer deaths in China nowadays. Without mass screening programs, unfortunately over 80% of all Chinese patients have been diagnosed as advanced diseases. As in other Asian countries, especially Japan and Korea, laparoscopic gastrectomy for the treatment of gastric cancer has gained increasingly popularity in China during the past decade. Whether laparoscopic surgery can be safely and effectively performed in the treatment of gastric cancer remains controversial, particularly with regard to curative intent in advanced diseases. Given the high incidence of these cancers, and their advanced stage at diagnosis, China has a significant interest in determining the safety and effectiveness of laparoscopic gastrectomy. A well‐designed randomized controlled trial (RCT) is considered the only feasible way to provide conclusive evidence. To date, China has not played a significant role in terms of conducting RCT concerning laparoscopic surgery for gastric cancer. However, an effort has been made by the Chinese researchers, with the great help from our colleagues in neighboring countries such as Korea and Japan, through the establishment of the Chinese Laparoscopic Gastrointestinal Surgery Study Group. In this review, we present the current status of RCT for laparoscopic gastric surgery for gastric cancer in China, including published and ongoing registered RCT.     

Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial

Background and aim

Enhanced recovery after surgery (ERAS) programs, following a variety of perioperative treatments with evidence‐based medical evidence, has indicated its validity to accelerate rehabilitation in a wide variety of surgical procedures. This randomized controlled trial (RCT) study was implemented to verify the safety and efficacy of the perioperative effects in patients undergoing hepatectomy with ERAS or with conventional surgery (CS).

Methods

From August 2016 to November 2017, according to the inclusion criteria, 160 patients with liver diseases were suitable for participating in this experiment. Patients before liver resection were randomized into ERAS group (n = 80) and CS group (n = 80), and then the outcome measures were compared between the two groups.

Results

Enhanced recovery after surgery group had significantly less complications than CS group (P = .009). Compared with CS group, patients in ERAS group had low peak of WBCs in postoperative day (POD1), ALT in POD1 and POD3 (P < .05), high value of ALB in POD3 and POD5 (P < .05), less pain and higher patient satisfaction (P < .001), earlier exhaust, oral feeding, ambulation and extubation time (P < .05),and also had less hospital stay and cost (P < .001). There were no significant differences in readmission rate (<30 days) between two groups (P = .772).

Conclusions

Enhanced recovery after surgery programs applied to patients undergoing hepatectomy can safely and effectively relieve stress response, reduce the incidence of complications, improve patient satisfaction, accelerate patient recovery, reduce financial burden, and bring economic benefits.

     

Laparoscopic colorectal cancer surgery: Japanese experience

In Japan, laparoscopic colectomy for cancer started in 1992. A national survey has revealed that, since that time, the number of cases that have undergone this procedure has steadily increased, and by 2007, there were over 9000 cases. This figure includes an increase in the percentage of more advanced cases, which has occurred due to technical improvements in lymph node dissection. A Japanese randomized controlled trial comparing laparoscopic to open surgery started in November 2004, with enrollment ending in April 2009 with 1050 cases. For this study, preoperative stage T3 and T4 cases were selected for inclusion, and D3 dissection was required. To assess the technical skill of surgeons, the Japan Society of Endoscopic Surgery established the Endoscopic Surgical Skill Qualification System to encourage high‐level surgical techniques. Assessment is conducted by reviewing unedited videos. The success rate for colon and rectal surgeries has ranged between 37%–40%. The Endoscopic Surgical Skill Qualification System has contributed to the establishment of standard technical skills in laparoscopic surgery, the development of an educational system for laparoscopic surgeons, and a reduction in the number complications. Technical difficulties still exist in laparoscopic rectal cancer surgery, but with the technical progress in laparoscopic colorectal surgery, the number of laparoscopic rectal cancer surgeries has been gradually increasing in number. A multicentric phase II study on the feasibility and long‐term outcome for stage I and II rectal cancer started in 2008. In this study, the short‐term outcomes including anastomotic leakage rate and long‐term survival, will be clarified. Combined with continuously improved technologies, training techniques and surgical standards, laparoscopic colorectal surgery is steadily progressing in Japan.     

Fast-track surgery in elderly patients undergoing colorectal cancer radical resection

PurposeTo investigate the efficacy of applying fast-track surgery (FTS) to elderly patients undergoing radical resection of colorectal cancer.MethodsElderly patients undergoing radical resection of colorectal cancer received FTS (n = 31) or routine (n = 31) nursing care. The time to first anal exhaust, oral feeding and leaving the bed, duration of postoperative hospital stay and the incidence of complications were compared between the two groups.ResultsPatients receiving FTS nursing demonstrated significantly shorter times to exhaust, oral feeding and leaving the bed compared with those receiving routine nursing (all p < 0.01). Furthermore, there were significantly fewer incidences of postoperative pulmonary and urinary tract infections and intestinal adhesion in patients receiving FTS nursing (all p < 0.05).ConclusionApplication of FTS in elderly patients undergoing radical resection of colorectal cancer facilitates an early rehabilitation after surgery, but places higher demands on nursing care.     

Systemic use of antibiotics does not prevent postoperative infection in elective colorectal surgery: a randomized controlled trial

We assessed the clinical impact of the systemic use of antibiotics on postoperative infection in colorectal surgery. Perioperative administration prevents postoperative infection: a statement which is based on the results of five randomized controlled trials performed in the 1970s and 1980s. Our study design was a randomized controlled trial. We created two groups, one using the systemic antibiotic cefotiam (CTM), and the other using no antibiotic as the control. The primary end point was the overall postoperative infection rate. There were 100 patients assigned to this study. The patients were divided into two groups; the control group consisted of 51 cases and the CTM group had 49 cases. The backgrounds of the patients in the two groups were not significantly different. The overall postoperative infection rate was 28/51 (54.9%) in the control group and 25/49 (51.0%) in the CTM group. The surgical site infection (SSIs) (superficial, deep, and space/organ ) were 23/51 (45.1%) in the control group and 20/49 (40.8%) in the CTM group. No significant difference was observed between the CTM group and the control group regarding postoperative infection after elective colorectal surgery.