加速康复外科在下咽癌手术治疗中的应用研究

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在下咽癌外科治疗中的临床应用价值。方法回顾性分析山东大学齐鲁医院2015年1月至2019年1月期间收治并进行手术的168例原发于梨状窝的下咽癌患者的病例资料,其中男164例,女4例,年龄42~84岁。根据围手术期处理方式不同,分为ERAS处理组(64例)和传统处理组(104例),运用t检验、χ²检验或Fisher精确检验等统计学方法,比较2组患者术中及术后恢复情况,包括手术时长、术后营养状态、并发症发生率、术后住院时间等指标。结果与传统处理组相比,ERAS处理组患者的手术时长显著缩短,差异有统计学意义(166.8±58.2)min比(183.3±39.9)min,t=-2.72,P=0.031],术后血清白蛋白水平(38.3±4.2)μmol/L比(36.6±3.3)μmol/L]及体重(65.4±9.4)kg比(62.1±9.4)kg]均明显提升,差异有统计学意义(t值为2.73、2.22,P值均<0.05),颈部切口皮下感染7.8%(5/64)比20.2%(21/104)]及重症肺炎的发生率4.7%(3/64)比15.4%(16/104)]显著下降,差异有统计学意义(χ²值分别为4.64、4.52,P值均<0.05),术后住院时间明显缩短,差异有统计学意义(16.5±3.9)d比(18.2±4.3)d,t=-2.65,P<0.05]。结论在下咽癌手术治疗中应用ERAS能够通过缩短手术时间以减轻患者手术应激,改善患者术后营养状态,缩短住院时间并减少并发症的发生,促进患者快速康复。

Implication of enhanced recovery after surgery in the surgical management of hypopharyngeal squamous cell carcinoma

Objective To investigate the safety and efficacy of enhanced recovery after surgery(ERAS)in the clinical management of hypopharyngeal squamous cell carcinoma(HSCC).Methods In this retrospective study,a total of 168 patients with pyriform sinus carcinoma in Qilu Hospital of Shandong University from January 2015 to January 2019 were divided into two groups,based on the different perioperative interventions that patients received,i.e.the ERAS group(n=64)and the conventional group(n=104),including 164 males and 4 females,whose ages ranged from 42 to 84 years old.The difference between two groups in the operative time,postoperative nutritional status,incidences of postoperative complications and postoperative hospitalization time were compared using the student′s t test,Chi-squared test or Fisher′s exact test.Results Compared with the conventional group,patients in the ERAS group had significantly shorter operative time(166.8±58.2)min vs.(183.3±39.9)min,t=-2.72,P=0.031],higher levels of postoperative serum albumin(38.3±4.2)μmol/L vs.(36.6±3.3)μmol/L,t=2.73,P=0.007]and more body weight(65.4±9.4)kg vs.(62.1±9.4)kg,t=2.22,P=0.028],lower incidences of postoperative subcutaneous infection7.8%(5/64)vs.20.2%(21/104),χ²=4.64,P=0.03]and severe pneumonia4.7%(3/64)vs.15.4%(16/104),χ²=4.52,P=0.03],and shorter postoperative hospitalization time(16.5±3.9)d vs.(18.2±4.3)d,t=-2.65,P<0.05].Conclusion ERAS is effective and safe in the surgical management of HSCC,with benefits in reducing the operative stress via saving operation time,shortening the hospitalization time,ameliorating nutritional status and decreasing the incidences of complications.