加速康复外科对胃癌根治术患者术后恢复的影响

发布时间：2018-05-06 02:35

本文选题：胃癌 + 加速康复　；参考：《广西医科大学》2017年硕士论文

【摘要】：第一部分胃癌加速康复外科临床实践可行性与安全性探讨1.目的:验证加速康复外科在胃癌根治术患者中应用的有效性及安全性。2.方法:回顾性研究我科2016年1月至2016年12月收治的172例胃癌根治术患者,根据患者围术期处理方案将患者分为传统组(Standard care group,SC组)及加速康复外科组(Enhanced Recovery After Surgery group,ERAS组)。在172例患者中,传统开放手术组(open gastrectomy with SC group,OG+SC组)44例,开放手术联合加速康复外科组(open gastrectomy with ERAS group,OG+ERAS组)57例,腹腔镜联合加速康复外科组(laparoscopic gastrectomy with ERAS group,LG+ERAS组)50例,机器人联合加速康复外科组(robot-assisted gastrectomy with ERAS,RG+ERAS组)21例。采用首次肛门排气时间、经口进食时间、下床活动时间、住院费用、术后住院时间、并发症发生率及疼痛评分变化情况等作为观察指标。并发症采用Clavin-Didno分级方式进行分级。3.结果与OG+SC组相比,OG+ERAS组、LG+ERAS组、RG+ERAS患者术后首次肛门排气时间、经口进食时间及术后下床活动时间均显著缩短(P0.001)。OG+SC组、OG+ERAS组、LG+ERAS组、RG+ERAS组术后首次肛门排气时间分别为84.09±24.73h、44.93±13.02h、44.68±15.33h、43.52±13.64h;经口进食时间分别为116.91±31.22h、39.63±13.92h、41.12±14.16h、37.19±11.79h;术后下床活动时间分别为78.73±27.70h、28.07±10.61h、28.28±13.56h、26.81±11.35h。在住院费用方面,与OG+SC组相比,OG+ERAS组、LG+ERAS组住院费用显著降低,而RG+ERAS组住院费用显著增高(P0.001)。OG+SC组、OG+ERAS组、LG+ERAS组、RG+ERAS组住院费用分别为71011.82±13505.14元、61276.32±6814.46元、61252.36±6444.84元、74269.86±9165.08元。与OG+SC组相比,OG+ERAS组、LG+ERAS组、RG+ERAS组术后住院时间显著缩短(P0.001)。OG+SC组、OG+ERAS组、LG+ERAS组、RG+ERAS组术后住院时间分别为11.05±4.02d、7.88±1.88d、7.64±2.30d和7.67±4.49d。OG+SC组、OG+ERAS组、LG+ERAS组、RG+ERAS组总并发症发生率无显著差异(P0.05)。各组并发症总发生率分别为6.8%、5.3%、6.0%、4.8%。在术后疼痛评分方面,与OG+SC组相比,OG+ERAS组、LG+ERAS组、RG+ERAS组术后疼痛评分均有所降低。OG+SC组、OG+ERAS组、LG+ERAS组、RG+ERAS组术后疼痛评分在术后第一日2.32±0.82、1.07±1.01、1.28±1.00、1.29±1.12,第二日1.95±0.42、0.51±0.73、0.78±0.86、0.86±0.94,第三日1.70±0.69、0.32±0.65、0.38±0.69、0.24±0.61,及第四日0.98±0.81、0.05±0.29、0.06±0.31、0±0比较差异具有统计学意义(P0.001)。4.结论加速康复外科在胃癌患者围术期应用是可行且安全的。第二部分胃癌加速康复外科临床评估体系初探1.目的:初步探讨患者主观感受评估系统的应用价值,比较不同围术期处理方式对胃癌患者术后短期生活质量的影响。2.方法:回顾性分析我科2016年8月至2016年12月收治的行胃癌根治术患者68例,其中OG+SC组21例,OG/LG+ERAS组26例、RG+ERAS组21例。应用Qo R-40评分系统对三组患者术前、术后d3及术后三周的主观感受情况进行评分。包括:情绪状态(45分)、身体舒适度(60分)、患者支持(35分)、自理能力(25分)及疼痛情况(35分)5个领域,每个条目根据程度的不同,分别对应1-5分的分值,总分越高,则生存质量越高。根据Qo R-40评分高低评估患者的术后生活质量水平。3.结果与OG+SC组相比,OG/LG+ERAS组、RG+ERAS组术前生存质量评分无统计学差异(P0.05),术后d3及术后3周的Qo R-40评分显著升高(P0.001)。OG+SC组、OG/LG+ERAS组、RG+ERAS组术前Qo R-40评分分别为175.15±2.82分、176.19±3.50分、175.71±2.46分;术后d3Qo R-40评分分别为147.06±4.45分、157.47±2.05分、166.53±0.93分;术后第三周评分分别为162.62±1.59、170.21±2.49、173.33±5.76。术后第三周时,应用加速康复外科路径的病例生活质量基本恢复至术前。4.结论(1)加速康复外科能使患者术后生活质量更快恢复至术前水平;(2)机器人手术术后患者生活质量优于其他术式。第三部分胃癌加速康复外科术中液体管理等问题探讨1.目的:探究年龄及术中控制输液量对胃癌患者术后恢复的影响。2.方法:回顾性研究我科2016年1月至2016年12月收治的128例实施加速康复外科方案的胃癌根治术患者。将纳入研究的患者分为3个年龄组:小于40岁为低年龄组(Young Age Group,YAG)、40-59岁为中年龄组(Middle Age Group,MAG)、大于60岁为高年龄组(Old Age Group,OAG)。按照患者单位体积单位时间液体入量进行四分位分组,小于第25百分位数为低入量组(Low Volume Group,LVG),介于第25-75百分位数(Medium Volume Group,LVG)为中入量组,大于第75百分位数为高入量组(High Volume Group,HVG)。3.结果YAG组、MAG组、OAG组术后肛门排气时间分别为45.90±15.42h、44.61±13.97h、43.98±13.53h;术后下床活动时间分别为26.65±8.99h、28.73±12.87h、27.33±11.62h;术后进食时间分别为39.85±10.93h、41.73±13.48h、36.79±14.79h;术后住院日分别为6.60±1.57h、7.85±2.98h、8.14±2.24h,各组结果比较,差异均无统计学意义(P0.05)。并发症方面,OAG组、MAG组、YAG组术后并发症发生率分别为10%、3%、7.1%,三组比较无显著差异(P0.05)。LVG组、MVG组、HVG组术后肛门排气时间分别为45.91±14.93h、45.82±12.72h、40.71±15.14h;术后下床活动时间分别为30.72±13.56h、27.98±11.27h、25.00±10.94h;术后进食时间分别为38.59±15.49h、40.35±12.94h、39.94±13.49h;术后住院日分别为8.03±2.57d、7.62±2.93d、7.74±1.88d,各组结果比较,差异均无统计学意义(P0.05)。并发症方面,OAG组、MAG组、YAG组术后并发症发生率分别为6.3%、4.6%、6.5%,三组比较无显著差异(P0.05)。4.结论年龄及术中液体入量可能不对加速康复外科患者术后恢复产生影响。
[Abstract]:The first part of the study on the feasibility and safety of accelerated rehabilitation surgery for gastric cancer 1. Objective: to verify the effectiveness and safety of accelerated rehabilitation surgery in patients with radical gastrectomy for gastric cancer: a retrospective study of 172 cases of radical gastrectomy in our department from January 2016 to December 2016, according to the perioperative treatment plan of the patients will be affected by.2.. The patients were divided into the traditional group (Standard care group, group SC) and the accelerated rehabilitation surgery group (Enhanced Recovery After Surgery group, ERAS group). In the 172 cases, the traditional open operation group (open gastrectomy) was 44 cases, and the open surgery combined accelerated rehabilitation surgery group was 57 cases. 50 cases (laparoscopic gastrectomy with ERAS group, LG+ERAS group), robot combined accelerated rehabilitation surgery group (robot-assisted gastrectomy with ERAS, RG+ERAS group) 21 cases, using the first anus exhaust time, oral feeding time, bed activity time, hospitalization expenses, postoperative hospitalization time, complications Compared with the OG+SC group, the results of the Clavin-Didno classification of the complications were compared with the OG+SC group. The first anus exhaust time of the OG+ERAS group, the LG+ERAS group, the RG+ERAS patients after operation, the time of oral feeding and the activity time after the operation were significantly shortened (P0.001).OG+SC group, OG+ERAS group, LG+ERAS group, RG+. The first anus exhaust time after operation in group ERAS was 84.09 + 24.73h, 44.93 + 13.02h, 44.68 + 15.33h, 43.52 + 13.64h, and the time of oral feeding was 116.91 + 31.22h, 39.63 + 13.92h, 41.12 + 14.16h, 37.19 + 11.79h, respectively, 78.73 + 27.70h, 28.07 + 10.61h, 28.28 + 13.56h. Compared with group OG+SC, the cost of hospitalization in group OG+ERAS and group LG+ERAS was significantly lower, while the hospitalization cost in group RG+ERAS increased significantly (P0.001).OG+SC group, and the hospitalization expenses of group OG+ERAS, LG+ERAS, and RG+ERAS were 71011.82 + 13505.14 yuan, 61276.32 + 6814.46 yuan, 61252.36 + 6444.84 yuan, 74269.86 + 9165.08 yuan, and OG+ERAS group and LG+ERAS group compared with OG+SC group. In group +ERAS, the time of hospitalization was significantly shortened (P0.001) in group.OG+SC, group OG+ERAS, group LG+ERAS, group LG+ERAS, and group RG+ERAS were 11.05 + 4.02d, 7.88 + 1.88d, 7.64 + 2.30d and 7.67 + 4.49d.OG+SC respectively. There was no significant difference in the incidence of complications in OG+ERAS group and LG+ERAS group. The total incidence of complications in each group was 6.8%, 5.3%, 6., respectively. 0%, 4.8%. in postoperative pain score, compared with group OG+SC, group OG+ERAS, group LG+ERAS, and group RG+ERAS had lower pain scores in group.OG+SC, OG+ERAS group, LG+ERAS group, and group RG+ERAS after operation. The postoperative pain score of group RG+ERAS was 2.32 + 0.82,1.07 + 1.01,1.28 + 1.00,1.29 + 1.12 on the first day after operation, and 1.95 + 1.95 + 0.94. Three days 1.70 + 0.69,0.32 + 0.65,0.38 + 0.69,0.24 + 0.61 and four days 0.98 + 0.81,0.05 + 0.29,0.06 + 0 the difference has statistical significance (P0.001).4. conclusion, accelerated rehabilitation surgery is feasible and safe in the perioperative application of gastric cancer patients. Second part of gastric cancer accelerated rehabilitation surgery clinical evaluation system 1. purposes: preliminary exploration To discuss the application value of the patient's subjective perception evaluation system and compare the effect of different perioperative treatment methods on postoperative short-term quality of life of gastric cancer patients.2.: a retrospective analysis of 68 patients with radical gastrectomy from August 2016 to December 2016, including 21 cases in group OG+SC, 26 cases in group OG/LG+ERAS, 21 cases in group RG+ERAS. The application of Qo R-40 The subjective feeling of three groups of patients before operation, postoperative D3 and three weeks postoperatively was scored, including emotional state (45 points), body comfort (60 points), patient support (35 points), self-care (25) and pain (35) in 5 fields, each item corresponding to 1-5 points, the higher the total score, the higher the total score, the quality of survival. According to the Qo R-40 score, the postoperative quality of life of the patients was evaluated by.3.. Compared with group OG+SC, there was no statistical difference between group OG/LG+ERAS and group RG+ERAS (P0.05), D3 and Qo R-40 score in 3 weeks after operation were significantly higher (P0.001).OG+SC group. 5 + 2.82 points, 176.19 + 3.50 points, 175.71 + 2.46 points, d3Qo R-40 scores were 147.06 + 4.45, 157.47 + 2.05, 166.53 + 0.93, and third weeks after the operation were 176.19 weeks after the surgery of 162.62 + 1.59170.21 + 2.49173.33 + 5.76. Rehabilitation surgery can make the patient's quality of life back to the preoperative level faster; (2) the quality of life of the patients after the robot surgery is better than that of other surgical procedures. Third part of the gastric cancer accelerated the recovery of the fluid management and other problems, 1. objectives: To explore the effect of age and intraoperative control of infusion on postoperative recovery of gastric cancer patients: a review of the.2. method: 128 patients who were treated with accelerated rehabilitation surgery from January 2016 to December 2016 were divided into 3 age groups: lower age group (Young Age Group, YAG), 40-59 years old age group (Middle Age Group, MAG), and higher age group than 60 years (Old Age Group, OAG). The unit volume per unit volume of the patient was divided into four sub groups, which were less than twenty-fifth percentiles as the low entry group (Low Volume Group, LVG), and the 25-75 percentile (Medium Volume Group, LVG) was the middle entry group, and the seventy-fifth percentile was the high entry group (High Volume Group, HVG). The exhaust time was 45.90 + 15.42h, 44.61 13.97h, 43.98 + 13.53h, and the activity time after operation was 26.65 + 8.99h, 28.73 + 12.87h, 27.33 + 11.62h, and the feeding time was 39.85 + 10.93h, 41.73 + 13.48h, 36.79 + 14.79h after operation, respectively. The postoperative hospital days were 6.60 + 1.57h, 7.85 + 2.98h, 8.14 + 2.24h. Statistical significance (P0.05). Complications, the incidence of postoperative complications in group OAG, group MAG, and group YAG was 10%, 3%, 7.1%, respectively. There was no significant difference in group three (P0.05).LVG, MVG group, and group HVG, 45.91 + 14.93h, 45.82 + 12.72h, 40.71 +, respectively, and 30.72 + 13.56h, 27.98 +, 25 after operation. 0 + 10.94h (38.59 + 15.49h, 40.35 + 12.94h, 39.94 + 13.49h) after operation were 8.03 + 2.57d, 7.62 + 2.93d, 7.74 + 1.88d, respectively, and the differences were not statistically significant (P0.05). The complications of group OAG, MAG, and YAG were 6.3%, 4.6%, 6.5%, and no significant difference. Differences (P0.05).4. conclusion age and intraoperative fluid intake may not affect postoperative recovery in patients undergoing accelerated rehabilitation surgery.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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