加速康复外科在腹腔镜辅助胃癌根治术中的应用及其对患者术后恢复、营养及应激的影响

目的:探讨腹腔镜辅助胃癌根治术中应用加速康复外科(ERAS)的疗效及其对患者术后恢复、营养及应激指标的影响。方法:前瞻性纳入2016年12月—2018年12月行腹腔镜辅助胃癌根治术的患者80例,随机分为常规组和ERAS组,每组各40例。常规组患者采用传统围期手术方法,ERAS组患者应用ERAS围手术期模式。比较两组患者围手术期相关临床指标,术后血清白蛋白(ALB)、C-反应蛋白(CRP)、白介素6(IL-6)、降钙素原(PCT)水平的变化,以及手术前后体质量比值(BWR)的变化。结果:两组患者术前各项指标均无统计学差异(均P0.05)。两组患者的手术方式、吻合方式、手术时间、术中出血量、淋巴结的清扫数量、术后病理分期、肿瘤大小间差异均无统计学意义(均P0.05),ERAS组患者术中补液总量、术后首次通气时间、术后排便时间、术后静脉输液时间、术后住院时间、住院总费用均明显少于常规组(均P0.05)。ERAS组术后第7天ALB水平明显高于常规组(P0.05);ERAS组术后第1、3、7天CRP、IL-6、PCT水平均明显低于常规组(均P0.05);ERAS组术后第7天BWR水平高于常规组(P0.05)。结论:ERAS模式应用于腹腔镜辅助胃癌根治术安全有效,且相对于传统模式更利于促进患者术后恢复、改善术后近期营养状况、减轻应激反应。

Application of enhanced recovery after surgery in laparoscopic assisted radical resection for gastric cancer and its influence on postoperative recovery, nutrition status and stress of the patients

Objective: To investigate the efficacy of using enhanced recovery after surgery (ERAS) in laparoscopic assisted radical resection for gastric cancer and its influence on postoperative recovery, nutritional status and stress parameters of the patients.   Methods: Eighty patients with gastric cancer scheduled to undergo laparoscopic assisted radical resection from December 2016 to December 2018 were prospectively enrolled, and were randomly allocated to conventional group and ERAS group, with 40 cases in each group. Patients in conventional group underwent the traditional perioperative management, and those in ERAS group received ERAS perioperative management. The relevant perioperative clinical variables, the changes in postoperative levels of serum albumin (ALB), C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin (PCT), as well as the changes in body weight ratio (BWR) before and after operation were compared between the two groups of patients. Results: All preoperative data between the two groups of patients showed no significant difference (all P>0.05). There were no significant differences between the two groups of patients in terms of operative procedures, anastomosis methods, operative time, intraoperative blood loss, number of the resected lymph nodes, postoperative pathological stages, and tumor size (all P>0.05), but the total volume of intraoperative fluid infusion, time to the first postoperative gas passage, time to the first postoperative defecation, length of time of postoperative venous infusion, length of postoperative hospital stay and hospitalization cost were significantly reduced in ERAS group compared with conventional group (all P<0.05). The ALB level was significantly higher on postoperative day (POD) 7, the levels of CRP, IL-6 and PCT were significantly lower on POD 1, 3 and 7, and the BWR value was significantly higher on POD 7 in ERAS group than those in conventional group (all P<0.05). Conclusion: Using ERAS protocol in laparoscopic assisted radical resection for gastric cancer is safe and effective, and is also superior to the traditional mode in promoting postoperative recovery, improving the nutritional status and reducing the stress response of the patients.