促进术后恢复综合方案在结直肠癌根治术患者中的应用

目的评价围手术期应用促进术后恢复综合方案（ERAS）对结直肠癌根治术患者术后恢复的促进作用。方法2007年7月至2010年5月间复旦大学附属中山医院普通外科结直肠专业组收治的597例结直肠癌根治术患者被前瞻性纳入研究．按随机数字表法分为ERAS组（299例）和对照组（298例）。ERAS组患者围手术期采用ERAS方案,包括一系列被证明有效的围手术期处理措施,而对照组患者围手术期采用传统方案。记录两组患者的营养代谢指标、应激指标及临床恢复指标。结果两组患者一般资料和手术方式的差异均无统计学意义（均P〉0．05）。ERAS组患者术后营养代谢指标（白蛋白、前白蛋白及转铁蛋白）均优于对照组（均P〈0．05）。ERAS组患者术后第1天胰岛素抵抗指数低于对照组患者（3．31±2．92比6．58±3．86,P〈0．01）。对照组患者术后第1天和第5天皮质醇水平均较术前显著升高（均P〈0．01）,而ERAS组患者直至术后第5天才较术前升高（P〈0．01）。ERAS组患者术后住院时间（5．7±1．6）d比（6．6±2．4）d,P〈0．01]和住院费用（15998±2655）元比（17763±3059）元,P〈0．01]均少于对照组患者;两组患者术后并发症发生率的差异无统计学意义9．7％（29／299）比9．4％（28／298）,P〉0．05]。结论ERAS方案可减轻手术应激,加快术后恢复。且不增加术后并发症的发生。

Application of enhanced recovery program after surgery(ERAS) in patients undergoing radical resection for colorectal cancer

Objective To compare the enhanced recovery program after surgery （ERAS） with conventional perioperative management in patients undergoing radical resection for eolorectal cancer. Methods The ERAS protocol included a combination of evidence-based and consensus methodology. A total of 597 consecutive patients undergoing elective eolorectal resection were randomized to either the ERAS（n=299） or the control group（n=298）. Outcomes related to nutrition and metabolism index, stress index, and recovery index were measured and recorded. Results Demographics and operative parameters were similar between the two groups（P〉0.05）. The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group. On postoperative day （POD） 1, the HOMA-IR in the ERAS group was significantly lower than that in the control group （P〈0.01）. The eortisol level in the control group was elevated on both POD 1 （P〈0.01） and POD 5 （P〈0.01） compared to the preoperative level. However, the cortisol level was not increased until POD 5（P〈O.01 ） in the ERAS group. The levels of TNF-α, IL-113, IL-6, and IFN-γ, were reduced in the ERAS group, indicating less postoperative stress responses compared with the control group. In addition, ERAS group was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay （5.7±1.6） d vs. （6.6±2.4） d, P〈0.01] and expense（15 998±2655） RMB vs. （17 763±3059） RMB, P〈0.01 ] were reduced in the ERAS group. Twenty-eight patients （9.4%） in the control group and 29 （9.7%） in the ERAS group developed complications, while the difference was not statistically significant （P〉0.05）. Conclusion ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety.