快速康复外科在结直肠癌择期手术中应用的临床研究

目的探讨结直肠癌手术快速康复外科中不常规留置胃肠减压管并早期进食的安全及可行性。方法随机选取解放军第85医院和长海医院2008年10月—2010年5月结直肠癌手术病人62例为胃肠减压组(A组),62例为非胃肠减压并早期恢复进食组(B组)。比较两组病例术后肛门恢复排气时间,咽部疼痛、恶心、急性胃扩张、切口感染、肺部感染、吻合口漏等手术后并发症的发生率。结果 两组比较B组肛门恢复排气时间显著提前(P<0.05),两组病人出现急性胃扩张、切口感染、肺部感染、吻合口漏等并发症发生率差异无统计学意义(P>0.05),但A组病人诉咽喉疼痛、恶心呕吐明显较B组增多(P<0.01)。两组均有发生急性胃扩张并发症而需要重置胃肠减压并禁食病例,但差异无统计学意义(P>0.05)。结论不常规放置胃肠减压管并早期恢复进食安全可行,有利于病人的术后恢复。

Fast tract surgery in elective operation for colorectal carcinoma

Objective To investigate the security and feasibility without routine nasogastric decompression and with early oral feeding in colorectal carcinoma fast track surgery.Methods Sixty-two patients who received gastrointestinal operation and were inserted nasogastric decompression tube were divided into control group(Group A),and meanwhile other 58 ones without routine nasgastric decompression tube and with early oral feeding according fast track surgery rules were divided into trial group(Group B).We compared their time to flatus,and the ratio of postoperative complication including throat ache,nausea,atelectasis,wound infection,pneumonia and anastomotic leak.Results Compared with Group A,the time to flatus was advanced in Group B(P<0.05).The ratio of throat ache and nausea in Group A increased significantly(P<0.01).And other postoperative complications were of no difference in the two groups.There were a few of patients needing reinsertion of nasogastric decompression tube because of atelectasis in the two groups,but no significant difference between them was found(P>0.05).Conclusion It is safe and feasible in colorectal carcinoma fast track surgery not to place routine nasogastric decompression tube and to start postoperatively early oral feeding.