快速康复外科在腹腔镜胃癌根治术围手术期的应用

目的:探讨快速康复外科(fast track surgery,FTS)在腹腔镜胃癌根治术围手术期临床应用的安全性及可行性。方法:将160例胃癌患者根据围手术期处理方案及手术技术随机分为4组,40例采用常规围手术期处理方案行开腹手术(A组),40例采用快速康复外科处理方案行开腹手术(B组),40例采用常规围手术期处理方案行腹腔镜手术(C组),40例采用快速康复外科处理方案行腹腔镜手术(D组)。对比分析4组患者各项手术指标、临床指标及并发症发生率。结果:C组、D组切口长度、术中出血量明显减少,但手术时间延长、住院费用明显增加,差异有统计学意义(P<0.05)。淋巴结清扫数量4组差异无统计学意义(P>0.05)。B、C、D组首次排气时间及住院时间均较A组缩短,差异有统计学意义(P<0.05)。D组与C组相比,首次排气时间、住院时间及住院费用差异无统计学意义(P>0.05)。结论:在快速康复外科指导下施术可促进患者早期排气,缩短住院时间;与开腹手术相比,腹腔镜手术具有术中出血少、切口小、术后早期下床活动等优势,且不增加手术并发症;但FTS腹腔镜手术与常规腹腔镜手术及FTS开腹手术相比,优势并不十分明显。

Perioperative application of fast track surgery in laparoscopic radical resections for gastric cancer

Objective:To evaluate the safety and feasibility of perioperative application of fast track surgery(FTS) in laparoscopic radical resections for gastric cancer.Methods:One hundred and sixty patients with gastric cancer were randomly divided into 4 groups according to perioperative management and surgical technique.Group A(40 cases) accepted open gastrectomy and traditional perioperative management.Group B(40 cases) accepted open gastrectomy and FTS management.Group C(40 cases) accepted laparoscopic gastrectomy and traditional perioperative management,and group D accepted laparoscopic gastrectomy and FTS management.The operation index,clinical index and complications were compared between the 4 groups.Results:The incision and blood loss in group C and D were less than group A and B,while the operation time was longer(P<0.05),and there was no significant difference in lymph node harvest(P>0.05).The recovery of bowel function and the postoperative hospital stay were shorter in group B,C and D(P<0.05)in group A.The cost in group C and D was significantly higher than in group A and B.There were no significant differences in the recovery of bowel function,postoperative hospital stay and cost between group C and D.Conclusions:The operation guided by FTS could promote recovery of bower function and shorten postoperative hospital stay.Compared with open surgery,laparoscopic gastric resection had advantages of less blood loss,smaller incision and earlier recovery without increasing complications.However,laparoscopic gastrectomy with FTS was not superior than open surgery with FTS and laparoscopic gastrectomy.