快速康复外科与腹腔镜技术对围手术期胃癌患者的影响

目的通过对比研究,分析快速康复外科（fast track surgery,FTS）与腹腔镜技术（laparoscopy,LAP）对胃癌手术患者围术期的影响。方法 60例拟施行远端胃癌患者随机分为两组：腹腔镜手术组（LAP组;n=30）行腹腔镜辅助远端胃癌根治术;快速康复外科组（n=30）应用FTS方案进行围手术期处理并开腹远端胃癌根治术（open distal gas-trectomy,ODG）。比较两组患者围手术期术后血清白蛋白、血尿素氮、C反应蛋白、肠蠕动恢复时间、手术时间、术中出血量、术后住院时间、住院费用、并发症发生等情况。结果 LAP组与FTS组各项指标水平在术前及术后各时相差异均无统计学意义（P〉0.05）,但术后FTS组ALB水平变化较LAP组更为缓和（P〈0.05）;LAP组较FTS组手术时间明显延长（P〈0.01）,术后肠蠕动恢复时间、术后住院时间无统计学差异,LAP组住院费用明显高于FTS组（P〈0.001）;两组术后并发症无统计学差别（P〉0.05）。结论 FTS＋ODG具有与LAP相近的促进胃癌病人术后恢复的近期效果,但更为经济、有效、安全、可行。

Impact of Fast Track Surgery and Laparoscopic Gastrectomy in Peri-operation Patients with Gastric Cancer

Objective Through the comparative study,to evaluate the effectiveness of fast track surgery(FTS) program and laparoscopy-assisted radical distal gastrectomy(LAP) in peri-peration patients with gastric cancer.Methods A total of 60 patients with distal gastric cancer were randomly divided into LAP group(n=30) undergoing LAP and traditional perioperative cares,and FTS+ODG(open distal gastrectomy) group(n=30) undergoing ODG and FTS treatments.The age,sex,body weight,anastomotic mode and pathological tumor stage,albumin(ALB),blood urea nitrogen(BUN),C-reaction protein(CRP),time of the recovery of intestinal peristalsis,operation time,blood loss during operation,flatus time,postoperative hospital stay,medical cost,and postoperative complication were compared between two groups.Results The indexes at different timepoints in two groups were similar(P>0.05),but the variation of post-operation ALB levels in LAP group was less than that in FTS+ODG group(P<0.05).There was longer operation duration and higher medical cost in LAP group(P<0.01).There was no difference in flatus time,postoperative hospital stay and postoperative complication between two groups.Conclusion FTS+ODG has similar near-term effectiveness as LAP in promoting the postoperative rehabilitation of patients with gastric cancer,but is more economical,effective,safe and feasible.