腔镜辅助下进展期胃癌加速康复临床观察

发布时间：2018-02-03 18:51

本文关键词： 加速康复外科腔镜辅助下进展期胃癌　出处：《青海大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨腹腔镜辅助下进展期胃癌根治术围手术期经加速康复外科处理的安全性、有效性。方法:收集并整理2015年5月至2016年11月期间,到青海大学附属医院胃肠外科就医的,行腹腔镜辅助下进展期胃癌根治手术的60例病例资料行回顾性病例分析,其中围手术期经加速康复外科处理的病例资料30例为试验组,经传统围手术期处理方法的病例资料30例为对照组。通过两组术前(性别、年龄)、术中(手术方式、手术时间、术中出血量、清扫淋巴结个数)、术后(p TNM分期、术后下床时间及通气时间、拔管时间、经口进流食时间、术后住院天数、住院总费用、并发症发生率)三方面进行安全性及有效性的对比。结果:通过试验组与对照组的对比,可见二者在一般临床资料(年龄、性别、手术方式、手术时间、术中出血量、清扫淋巴结个数、p TNM分期)之间无差异(P0.05),具有可比性。二者在下床时间及通气时间、拔管时间、经口进流食时间、术后住院天数和住院总费用之间分别对比存在差异(P0.05)。此中,加速组较传统组的术后下床时间(16.07±4.41 vs.49.10±15.25)、通气时间(46.10±16.69 vs.86.33±19.14)、拔尿管时间(1.13±0.35 vs.3.27±0.58)、拔胃管时间(2.63±0.76 vs.6.17±1.74)、拔腹腔引流管时间(7.10±2.55 vs.9.93±3.70)、经口进流食时间(2.60±0.93 vs.7.73±1.91)、术后住院天数(9.80±1.32 vs.15.87±4.87)均缩短,住院费用(65088.02±10451.94 vs.71145.16±14165.37)较之减少;二者在术后并发症方面差异无统计学意义(P0.05)。结论:在手术后并发症未提高的前提下,应用加速康复处理的腹腔镜辅助下进展期胃癌患者,下床时间提前,通气时间也提前,拔管时间比之缩短,经口进流食时间提前,手术以后的住院时间减少,住院总花费却较之降低。一定程度上证实了,其在临床工作中的安全性及有效性,故建议推广加速康复外科在腔镜辅助下进展期胃癌患者中的应用。
[Abstract]:Objective: to investigate the safety and efficacy of laparoscopic assisted radical gastrectomy for advanced gastric cancer during the perioperative period of accelerated rehabilitation surgery. Methods: from May 2015 to November 2016. A retrospective analysis of 60 cases of laparoscopic assisted radical gastrectomy for gastric cancer was performed in the department of gastrointestinal surgery in the affiliated hospital of Qinghai University. Among them, 30 cases were treated by accelerated rehabilitation surgery in perioperative period as experimental group, 30 cases by traditional perioperative method as control group, and 30 cases were treated by pre-operation (sex, age) in two groups. Intraoperative (mode of operation, time of operation, amount of blood lost during operation, number of lymph nodes dissected, TNM stage after operation, time of getting out of bed, time of ventilation, time of extubation, time of feeding through mouth). Results: through the comparison between the trial group and the control group, we can see that the two in general clinical data (age, sex). There was no significant difference between operation mode, operation time, intraoperative bleeding volume and lymph node dissection TNM stage (P 0.05), the two were comparable in the time of getting out of bed, time of ventilation and time of extubation. There were significant differences in the time of feeding through the mouth, the days of hospitalization and the total cost of hospitalization. The time of getting out of bed was 16.07 卤4.41 vs.49.10 卤15.25 in accelerated group than in traditional group. The time of ventilation was 46.10 卤16.69 vs.86.33 卤19.14 vs.86.33, and the time of extubation was 1.13 卤0.35 vs.3.27 卤0.58). The time of gastric tube extraction was 2.63 卤0.76 vs.6.17 卤1.74 vs.6.17, and that of abdominal drainage tube was 7.10 卤2.55 vs.9.93 卤3.70). The feeding time was 2.60 卤0.93 vs.7.73 卤1.91 vs.7.73 and the postoperative hospitalization time was 9.80 卤1.32 vs.15.87 卤4.87). The cost of hospitalization was 65088.02 卤10451.94 vs.71145.16 卤14165.37). There was no significant difference in postoperative complications between the two groups (P 0.05). Conclusion: under the premise of no improvement of postoperative complications, laparoscopic assisted treatment with accelerated rehabilitation is used in patients with advanced gastric cancer. The time of getting out of bed was earlier, the time of ventilation was earlier, the time of extubation was shorter than that of extubation, the time of feeding through the mouth was earlier, the time of hospitalization after operation was reduced, but the total cost of hospitalization was lower than that of others. It is suggested to promote the application of accelerated rehabilitation surgery in patients with advanced gastric cancer assisted by endoscopy.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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