腹腔镜辅助下D2根治术联合快速康复理念对进展期胃癌患者近期预后的影响

目的探讨腹腔镜辅助下D2根治术联合快速康复理念对进展期胃癌患者近期预后的影响。方法选择2013年2月-2015年1月该院普外科接受手术治疗的96例进展期胃癌患者作为研究对象,按随机数字表法分为观察组与对照组各48例,对照组采用开腹根治术+常规围术期管理,观察组采用腹腔镜辅助下D2根治术联合加速康复外科(ERAS)管理,比较两组手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、排便时间、住院时间及手术并发症发生率,术后不同时间点采用视觉模拟评分(VAS)评定患者术后疼痛程度,两组均进行为期2年的随访调查,统计术后复发率及随访2年生存率,采用胃癌生活质量问卷(QLQ-STO22)评定手术前后患者生活质量的改善情况。结果 (1)观察组术中出血量少于对照组,术后肛门排气时间、排便时间及住院时间均短于对照组(P0.05),术后切口感染发生率低于对照组(P0.05);(2)术后1 d、术后3 d、术后1周,两组VAS评分均降低(P0.05),观察组术后不同时间VAS评分均低于对照组(P0.05);(3)两组随访2年生存率及复发情况比较差异均无统计学意义(P0.05);(4)术后6个月、术后1年、术后2年两组生活质量评分均降低(P0.05),观察组术后不同时间生活质量评分均低于对照组(P0.05)。结论腹腔镜辅助下D2根治术联合ERAS理念治疗进展期胃癌根治效果与开腹手术相似,患者近期预后相近,但可减少术中出血量,减轻患者术后疼痛程度,缩短其术后恢复时间,提升患者生活质量。

Effect of laparoscope assited D2 radical resection combined with enhanced recovery after surgery concept on the short-term prognosis of patients with advanced gastric cancer

Abstract: Objective?To investigate the effect of laparoscope assisted D2 radical resection combined with enhanced recovery after surgery (ERAS) concept on the short-term prognosis of patients with advanced gastric cancer.?Methods?96 patients with advanced gastric cancer who underwent surgical treatment from January 2013 to February 2015 were selected as the subjects, and they were divided into observation group and control group with 48 cases in each by random number table method. The control group were treated with open radical resection and conventional perioperative management, while the observation group were treated with laparoscope assisted D2 radical resection combined with ERAS management. The operation time, intraoperative blood loss, the number of dissected lymph nodes, postoperative anal exhaust time, defecation time, hospital stay and the incidence of complications were compared between the two group. The postoperative pain degree was evaluated with visual analogue scale (VAS) at different time points after operation. The two groups were followed up for 2 years, and the recurrence rate and 2-year survival rate were statistically analyzed. The improvement of quality of life was evaluated with the quality of life questionnaire for patients with gastric cancer (QLQ-STO22).?Results?The intraoperative blood loss, postoperative anal exhaust time, defecation time and hospital stay of the observation group were less?/?shorter than those of the control group (P??0.05). Quality of life scores of the two groups were decreased at 6 months, 1 year and 2 years after operation (P?