NOSE手术联合加速康复理念在结直肠癌治疗中的应用

发布时间：2018-01-27 13:50

本文关键词： 结直肠肿瘤 NOSE 手术 ERAS 腹腔镜　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景及目的:目前结直肠癌的治疗方法包括手术、放疗、化疗等,而手术切除肿物是目前结直肠癌根治性治疗的首选治疗方法,随着外科技术和手术器械的不断发展,腹腔镜微创手术成为外科治疗的主流方式,得到广泛开展。NOTES手术比腹腔镜手术更加微创,几乎达到了体表“无疤”的最高境界,仍而其尚有许多关键的问题未能很好解决,腹腔镜手术与NOTES手术各有优缺点,对此,NOSE手术的出现是腹腔镜手术的操作优势和NOTES手术的微创理念相结合的产物,可以说是“完美结合”,达到经自然腔道取标本的腹壁无辅助切口手术,较传统腹腔镜创伤小,术后恢复更快。在另一方面,ERAS理念通过优化围手术期措施,包括术前、术中及术后处理等一系列的围手术期治疗干预措施,减少患者机体内平衡的干扰,减少各种应激反应,提高患者手术疗效及降低术后并发症,加快术后康复,缩短住院时间。腹腔镜手术、NOSE手术及ERAS理念都是以减少患者术后应激、提高患者临床治疗效果、加速患者康复为目的。那么,NOSE手术联合加速康复外科理念在结直肠癌患者中的应用效果如何?本研究探讨经自然腔道标本取出(NOSE)手术联合快速康复外科(ERAS)理念在乙状结肠及直肠上段癌治疗中的应用。对象与方法:本研究通过选取2013年10月至2016年2月间南方医科大学附属珠江医院普外科收治的90例乙状结肠癌和直肠上段癌患者随机分为:传统护理对照组(腹腔镜手术加传统护理方案)、腹腔镜对照组(传统腹腔镜手术加ERAS方案)和NOSE组(NOSE手术加ERAS方案),行随机对照研究比较3组患者术中及术后情况及疼痛评分。结果:3组患者手术均顺利完成,无患者死亡,患者麻醉时间、手术时间和术中出血量差异无统计学意义(均P0.05);腹腔镜对照组术后首次排气时间、术后首次排粪时间、术后住院时间、平均住院费用及术后并发症发生率低于传统护理对照组,NOSE组术后首次排气时间、术后首次排粪时间、术后住院时间、平均住院费用及术后第三天的CRP、IL-6、皮质醇指标及均低于其他两组,各差异均有统计学意义(均P0.05);腹腔镜对照组患者术后疼痛评分优于传统护理对照组患者,而NOSE组患者术后疼痛评分优于其他两组,差异均具有统计学意义(均P0.05)。结论:采用NOSE手术联合ERAS方案治疗乙状结肠及直肠上段癌患者,较传统腹腔镜治疗及其联合ERAS方案更有优势。
[Abstract]:Background and objective: at present, the treatment of colorectal cancer includes surgery, radiotherapy, chemotherapy and so on. Surgical resection of tumor is the first choice of treatment for colorectal cancer. With the continuous development of surgical techniques and instruments, laparoscopic minimally invasive surgery has become the mainstream of surgical treatment, and has been widely developed. NOTES surgery is more minimally invasive than laparoscopic surgery. Almost reached the highest level of "no scar" on the body surface, but there are still many key problems to be solved. Laparoscopic surgery and NOTES surgery have their own advantages and disadvantages. The appearance of NOSE surgery is the result of the combination of the advantages of laparoscopic surgery and the idea of minimally invasive NOTES surgery, which can be said to be a "perfect combination". The abdominal wall without assistant incisions through the natural cavity is less traumatic than the traditional laparoscopic surgery, and the postoperative recovery is faster. On the other hand, the ERAS idea is to optimize the perioperative measures, including preoperative. During and after a series of perioperative treatment intervention measures to reduce the interference of the balance of patients, reduce all kinds of stress reactions, improve the effectiveness of surgery and reduce postoperative complications, accelerate postoperative rehabilitation. The purpose of laparoscopic surgery and ERAS is to reduce postoperative stress, improve the clinical effect of patients, and accelerate the recovery of patients. How effective is NOSE surgery combined with accelerated rehabilitation surgery in patients with colorectal cancer? The purpose of this study was to investigate the combination of the removal of the specimens from the natural canal and the rapid rehabilitation surgery (ERASS). Application of the concept in the treatment of sigmoid and upper rectal cancer. Objects and methods:. From October 2013 to February 2016, 90 patients with sigmoid and upper rectal cancer were randomly divided into:. Traditional nursing control group (. Laparoscopic surgery plus traditional nursing protocols). Laparoscopic control group (traditional laparoscopic operation plus ERAS regimen) and NOSE group with no operation plus ERAS regimen). A randomized controlled study was conducted to compare the intraoperative and postoperative conditions and pain scores in the three groups. Results all the patients in the 3 groups were successfully operated without death and anesthesia time. There was no significant difference in the time of operation and the amount of blood loss during operation (all P 0.05). The time of first exhaust after operation, the time of first excrement, the time of hospitalization, the average cost of hospitalization and the incidence of postoperative complications in the laparoscopic control group were lower than those in the traditional nursing control group. The time of first defecation postoperative hospitalization average hospitalization cost and CRP IL-6 on the third day after operation were lower than those in the other two groups. All the differences were statistically significant (P 0.05). The postoperative pain score of the patients in the laparoscopic control group was better than that in the traditional nursing control group, while the postoperative pain score in the NOSE group was better than that in the other two groups. The difference was statistically significant (P0.050.Conclusion: NOSE combined with ERAS regimen was used to treat cancer of sigmoid colon and upper rectum. Compared with traditional laparoscopic therapy and combined with ERAS regimen has more advantages.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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