快速康复外科在基层医院腹腔镜结直肠癌手术中的应用

目的:评估快速康复外科在基层医院腹腔镜结直肠癌手术中的应用效果。方法:纳入2017年1月至2018年12月在我院行腹腔镜结直肠癌手术的患者116例为研究对象,根据围术期康复方案,将其分成A组(67例)和B组(49例),分别接受快速康复方案和传统康复方案。结果:A组患者口渴感,饥饿感,均低于B组(11.9%和53.1%,...     

快速康复外科技术在结直肠癌中应用的研究进展

快速康复外科(enhanced recovery after surgery,ERAS)也称为快通道外科(fast-track surgery,FTS),是指采用一系列有循证医学证据证实的围手术期多模式优化的措施,以减少患者创伤应激,达到快速康复的目的。ERAS技术已广泛应用于结直肠癌患者,该文就近年来ERAS技术对结直肠癌患者应激反应、免疫、胰岛素抵抗等作用的研究进展作一综述。     

基于快速康复外科理论的多模式镇痛在腹腔镜结直肠癌根治术中的实施效果

目的探讨基于快速康复外科(FTS)理论的多模式镇痛在腹腔镜结直肠癌根治术术后镇痛中实施效果。方法选取腹腔镜结直肠癌根治术患者100例,随机分为两组,对照组50例,采用常规围术期疼痛管理,观察组50例,采用以FTS理论为基础的多模式镇痛,对两组的疼痛管理效果进行比较。结果术后6 h、12 h、24 h比较,观察组视觉模拟量表(VAS)评分均明显优于对照组(P0.05),两组Ramsay评分则无明显差异(P0.05)。术前比较,两组白细胞介素(IL)-6、C反应蛋白(CRP)水平均无明显差异(P0.05),术后12 h、24 h比较,两组IL-6、CRP差异显著(P0.05)。两组首次排便时间、首次排气时间、首次下床活动时间、住院时间比较差异均有统计学意义(P0.05)。与对照组比较,观察组并发症发生率明显降低(P0.05)。结论 FTS理论下多模式镇痛可减轻腹腔镜结直肠癌根治术患者疼痛,减轻应激反应。     

加速康复外科在结直肠癌中的应用

加速康复外科（ERAS）是一种优化的围手术期的先进理念,包含一系列能够促进患者术后康复,减少手术应激及并发症,缩短住院时间,降低住院费用的措施。ERAS理念在外科领域得到了广泛应用和推广,但目前国内ERAS的普及率仍很低,这可能与外科医师和患者对这一概念的认识不足有关。本文对ERAS在结直肠癌中的应用及最新进展做一综述,并深入分析ERAS对结直肠癌患者长期生存率的影响,为ERAS在结直肠肿瘤外科中的推广应用提供参考,从而使更多结直肠癌患者从中受益。     

快速康复外科新理念在结直肠癌患者围术期的应用

快速康复外科(fast-track surgery,FTS)也称为加速康复外科,是指采用一系列有循证医学证据的围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,以达到病人快速康复的目的[1~3].其核心是减少病人的创伤和应激损害,不仅要求手术微创,而且更重视围术期的其他处理对手术病人康复的影响[1,2].     

快速康复理念在老年结直肠癌患者腹腔镜手术中的应用

快速康复外科(FTS)的概念本在2001年由丹麦外科医生Kehlet首先提出[1],其目的是采取各种围术期处理方法,加速患者康复,缩短住院时间,降低住院费用,以应付政府及医院越来越增加的医疗负担.该理念一经提出在世界范围引起响应,尤其是在结直肠手术方面被广泛采纳,而腹腔镜结直肠癌手术更是早已被外科医生接受,成为结直肠癌手术的标准术式[2].本文总结我科65例老年结直肠癌患者行腹腔镜结直肠癌根治术的临床资料,体会快速康复理念在老年患者围术期中的应用.     

加速康复外科在老年结直肠癌手术中的临床应用

加速康复外科(FTS)是指采用一系列有循证医学证据的围术期处理优化措施,减少手术病人生理和心理的创伤应激以达到病人快速康复的目的,从而可缩短住院时间,降低医疗费用〔1,2〕。FTS可能彻底改变许多疾病的治疗模式,本文通过探讨FTS理念在结直肠手术中应用的可行性、有效性、安全性。     

快速康复护理在腹腔镜结直肠癌根治术并高血压围术期的应用

目的 研究为合并高血压的腹腔镜结直肠癌根治术患者于围术期开展快速康复护理的效果。方法 本文研究样本均为2021年4月至2022年4月间,在本院接受手术治疗的同时并发高血压的腹腔镜结直肠癌根治术患者,样本数量为62例,遵照简单随机分组原则进行分组处理,对照组均接受常规围术期护理,观察组则应用快速康复护理。将组间围术期血压水平、术后恢复指标展开比对。结果 护理工作开展前,两组的舒张压测定值和收缩压测定值相比,差异无统计学意义（P>0.05）;观察组患者术日晨间以及术后72 h晨间舒张压测定值、收缩压测定值均明显低于对照组（P<0.05）;观察组术后恢复指标当中,排气时间、第一次下床时间、第一次进食时间均明显短于对照组（P<0.05）。结论 患有高血压且行腹腔镜结直肠癌根治术患者于围术期应用快速康复护理的效果理想,具有进一步推广应用的价值。     

快速康复外科技术在结直肠癌患者围手术期的应用

将同期拟行手术治疗的80例结直肠癌患者随机分为观察组和对照组各40例，分别采用快速康复外科（FTS）技术及传统方法进行围手术期处理，观察两组术后排气、排便时间及住院时间、住院费用、术后并发症发生率、再入院率等。结果观察组排气、排便时间及住院时间明显短于对照组，住院费用、术后并发症发生率明显低于对照组。认为采用FTS技术对结直肠癌患者进行围手术期处理可促进患者康复、减少费用。     

Fast-track program vs traditional care in surgery for gastric cancer

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surgery for gastric cancer.     

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.     

快速康复在结直肠手术中的应用

近年来,快速康复外科(fast-track surgery,FTS)引起了越来越多人的重视.然而多数人对其应用于结直肠手术的安全性及有效性心存顾虑.本文综述了FTS主要组成部分(不常规行机械肠道准备,硬膜外麻醉及镇痛,腹腔镜手术,早期移除鼻胃减压管、引流管,术后早期进食)对择期行结直肠手术的患者的术后并发症发生率的影响.同时对FTS的有效性(缩短住院日,加速康复,降低胰岛素抵抗,保护机体免疫功能)也进行了详细的论述.另外,我们还总结了FTS实施过程中遇到的困难.最后,我们得出这样的结论:FTS应用于结直肠手术是安全有效的,并且应该被广泛推广.     

Effect of extended radical resection for rectal cancer

AIM: To discuss the rationality of extended radical resection (ERR) and to guide the surgical treatment of rectal cancer. METHODS: Total 211 patients who underwent ERR from 1981 to 1987 (follow-up rate of 94.8 %) were selected to study the patterns of lymphatic metastasis and therapeutic effect. The control group was made of 293 patients with rectal cancer who underwent conventional radical resection (CRR) and its follow-up rate was 98.5 %. The lymph node specimens, obtained by the triple-approach lymph node resection during the radical resection of rectal cancer, were studied by conventional pathological method. The extended radical resection, guided by the patterns of lymphatic metastasis, was applied in the clinical practice. RESULTS: The incidence of lymphatic metastasis in Chinese patients with advanced rectal cancer was 43.6 %, and that of the upper 2nd and 3rd groups and the lateral group was 14.2 %, 10.9 % and 11 % respectively. The 5,10-year-survival rates of the ERR were 68.0 % and 47.0 %, respectively, which were much higher than those of the conventional radical resection (42.9 % and 25.3 %). CONCLUSION: The ERR for rectal cancer removes all the lymph nodes, prevents possible metastasis and finally improves the survival rate.     

腹腔镜低位直肠癌根治术的研究进展

随着腹腔镜设备和技术的迅速发展,手术经验的不断积累,应用腹腔镜治疗低位直肠癌根治效果好、安全性高,具有手术视野清晰、创伤小、生理干扰轻及术后正常活动恢复快的优势。为了探讨腹腔镜低位直肠癌手术的疗效,不断提高患者满意的肛门功能和生活质量,该文对近年来腹腔镜低位直肠癌根治术的研究概况进行综述。     

直肠癌根治术中保护性肠造口相关问题探讨

直肠癌是发病率较高的恶性肿瘤之一，直肠癌根治术是治疗直肠癌的重要方法，保护性肠造口可以降低直肠癌根治术吻合口漏带来的不利影响，一定程度上挽救了患者的生命。本文将针对直肠癌根治术中保护性肠造口的相关问题进行总结与探讨，主要包括保护性肠造口的利弊、开放与还纳时机、转为永久性肠造口以及相关心理问题。     

腹腔镜直肠癌根治术的研究进展

随着腹腔镜直肠癌根治手术的改进,其应用也越来越广泛,其手术的安全性、可行性、远期疗效及根治性也逐渐得到认可。该文对其研究进展作一综述。     

Venous resection in pancreatic cancer surgery

Vascular resection and reconstruction at the time of pancreaticoduodenectomy (PD) adds complexity to an already demanding operation. In this chapter, we review the indications, surgical techniques, and most recent results of venous resection combined with PD. The need for venous resection may not always be apparent on preoperative imaging, and surgeons who perform PD should be familiar with standard techniques necessary for vascular resection and reconstruction. Recent data suggest that with proper patient selection and surgeon experience, vascular resection and reconstruction can be performed safely and does not impact survival duration even in patients with pancreatic ductal adenocarcinoma. The median survival of patients who underwent PD and required vascular resection was 23 months, approximately 1 year longer than the survival of patients with locally advanced, surgically unresectable pancreatic cancer who receive palliative chemotherapy or chemoradiation.