加速康复外科理念在老年患者腹腔镜辅助胃癌根治术中的应用

Application of enhanced recovery after surgery in laparoscopic-assisted radical gastrectomy for elderly patients

摘要:

目的 探讨实施腹腔镜辅助胃癌根治术老年患者应用加速康复外科理念(ERAS)的效果及安全性。方法 入选铜陵市人民医院胃肠外科2015年12月至2018年12月拟行腹腔镜辅助胃癌根治术患者80例,随机数表法分为ERAS组和常规组,每组40例,比较2组患者术后相关指标和并发症。应用SPSS 22.0统计软件对数据进行分析。依据数据类型,采用t检验或χ²检验进行组间比较。结果 相比常规组,ERAS组术后首次通气时间[(53.77±23.53)和(64.24±22.44)h]、首次排便时间[(60.92±22.15)和(75.10±22.25)h]、首次下床活动时间[(18.77±3.27)和(26.67±4.29)h]、首次经口流质饮食时间[(22.26±9.64)和(89.47±13.39)h]、肠外营养时间[(5.43±1.57)和(7.46±1.45)d]、腹腔引流管拔除时间[(4.90±1.24)和(6.60±1.04)d]和住院时间[(8.73±1.80)和(10.83±2.07)d]短,术后住院费用[(5.35±0.58)万元和(6.06±0.65)万元]低,差异均有统计学意义(P＜0.05)。ERAS组相比常规组咽喉疼痛[7.5%(3/40)和27.5%(11/40)]、切口疼痛＞Ⅱ级[5.0%(2/40)和20.0%(8/40)]、术后并发症Clavien-DindoⅠ级[17.5%(7/40)和37.5%(15/40)]发生率低,差异均具有统计学意义(P＜0.05)。结论 ERAS在老年患者腹腔镜胃癌根治术中应用安全有效,可降低术后并发症Clavien-DindoⅠ级发生率。

Abstract:

Objective To investigate the effect and safety of enhanced recovery after surgery (ERAS) in the elderly patients undergoing laparoscopic-assisted radical gastrectomy. Methods From December 2015 to December 2018,80 patients undergoing laparoscopic-assisted radical gastrectomy were randomly divided into ERAS group and routine group (n=40 in each). The two groups were compared in postoperative indicators and complications. SPSS statistics 22.0 was used to analyze the data, and depending on data type, t test or χ² test was used for comparison between the two groups. Results Compared with the routine group, the ERAS group had shorter time before the first exhaust [(53.77±23.53) vs (64.24±22.44)h] and the first defecation [(60.92±22.15) vs (75.10±22.25)h]; earlier ambulation [(18.77±3.27) vs (26.67±4.29)h], oral feeding for liquids [(22.26±9.64) vs (89.47±13.39)h], postoperative parenteral nutrition[(5.43±1.57) vs (7.46±1.45)d] and removal of peritoneal drainage [(4.90±1.24) vs (6.60±1.04)d]; shorter postoperative hospital stay [(8.73±1.80) vs (10.83±2.07)d]; and lower postoperative hospitalization expenses [(5.35±0.58)×10⁴ vs (6.06±0.65) ×10⁴ yuan], all differences being statistically significant (P<0.05). ERAS group had significantly lower incidences than the routine group of sore throat [7.5%(3/40) vs 27.5%(11/40)], incision pain above grade Ⅱ[5.0%(2/40) vs 20.0%(8/40)], and postoperative complications of Clavien-Dindo grade Ⅰ [17.5%(7/40) vs 37.5%(15/40)], all differences being statistically significant (P<0.05). Conclusion ERAS is safe and effective in the elderly patients undergoing laparoscopic-gastric radical gastrectomy and can reduce postoperative Clavien-Dindo grade Ⅰ complications.