加速康复外科在腹腔镜胃癌手术中的应用

陈锐 蒋玭露 周申康 陈建辉

[摘要] 目的 探讨加速康复外科（Enhanced recovery after surgery，ERAS）在腹腔镜胃癌根治术中的具体应用。 方法 回顾性分析2015年1月～2018年6月在臺州医院胃肠外科手术治疗的279例胃癌患者临床资料，所有病例均行腹腔镜胃癌D2根治术，其中122例应用加速康复外科理念治疗（ERAS组），157例按照传统围手术期治疗方案（传统组），比较两组手术时间、术中出血量、肛门排气时间、术后进食时间、平均住院费用、平均住院时间、引流管数量、术后30 d内并发症及非计划再住院发生状况。 结果 ERAS组与传统组患者手术时间、术中出血量比较无显著性差异（P>0.05）。相比于传统组患者，ERAS组患者肛门排气时间缩短，术后进食时间提前，平均住院费用下降，平均住院时间缩短，引流管数量减少（P<0.05）。ERAS组与传统组患者30 d内并发症发生率、30 d内非计划再住院率比较，差异无统计学意义（P>0.05）。 结论 腹腔镜胃癌手术应用ERAS是安全、有效的，有助于加速患者康复。

[关键词] 加速康复外科;腹腔镜胃癌手术;胃癌根治术;循证医学

[中图分类号] R735.2          [文献标识码] B          [文章编号] 1673-9701（2020）17-0087-05

Application of enhanced recovery after surgery in laparoscopic gastric cancer surgery

CHEN Rui   JIANG Pinlu   ZHOU Shenkang   CHEN Jianhui

Department of Gastrointestinal Surgery， Taizhou Hospital of Zhejiang Province， Linhai   317000， China

[Abstract] Objective To explore the specific application of enhanced recovery after surgery （ERAS） in laparoscopic radical surgery for gastric cancer. Methods The clinical data of 279 patients with gastric cancer who underwent surgery in department of gastrointestinal surgery in Taizhou Hospital from January 2015 to June 2018 were retrospectively analyzed. All patients underwent laparoscopic D2 radical surgery for gastric cancer. 122 patients were treated according to enhanced recovery after surgery （ERAS group）. 157 patients were treated according to the traditional perioperative treatment plan （traditional group）. The operation time， intraoperative blood loss， anal exhaust time， postoperative eating time， average hospitalization cost， average hospitalization time， the number of drainage tubes， complications and the status of unplanned rehospitalization within 30 days after surgery were compared. Results There was no significant difference in the operation time and intraoperative blood loss between the ERAS group and the traditional group（P>0.05）. Compared with the traditional group， the ERAS group had shorter anal exhaust time， earlier postoperative feeding time， lower average hospitalization costs， shorter average hospitalization time， and fewer drainage tubes（P<0.05）. There was no significant difference in the incidence of complications and the rate of unplanned rehospitalization within 30 days between the ERAS group and the traditional group（P>0.05）. Conclusion The application of ERAS in laparoscopic gastric cancer surgery is safe and effective， which can help accelerate the recovery of patients.

[Key words] Enhanced recovery after surgery; Laparoscopic gastric cancer surgery; Radical surgery for gastric cancer; Evidence-based medicine

胃癌是全球第五位最常診断的肿瘤，第三位致死的肿瘤[1]。中国的胃癌防治形式严峻，居恶性肿瘤发生率的第二位，死亡率居恶性肿瘤致死的第三位[2]。Kitano S等[3]在1994年首次报道了腹腔镜辅助胃癌根治术，经过20多年的不断进步和发展已逐步走向成熟，目前已经在国内外大的临床中心迅速发展[4]，并有腹腔镜辅助、全腹腔镜、3D腹腔镜及达芬奇机器人手术等多种形式。同样在20世纪90年代，丹麦外科医生Kehlet H[5]提出了加速康复外科（ERAS）理念，按照循证医学证据来整合围手术期的优化处理措施，减轻患者心理和生理上的创伤应激反应，减少能量损耗，从而促进术后早期恢复[6]。20……