腹腔镜联合快速康复外科在克罗恩病回盲部切除中的应用

发布时间：2019-02-14 23:56

【摘要】：背景:近年来快速康复外科(ERAS)在普外科、心脏外科、骨科、妇科等领域已经得到成功实践。尤其在结直肠肿瘤领域,腹腔镜结合快速康复外科治疗已经得到了广泛认同。由于克罗恩病的疾病特性,手术并发症较高,腹腔镜联合快速康复外科在克罗恩病外科治疗上仍未得到广泛应用。目的:探讨腹腔镜联合快速康复外科治疗在克罗恩病回盲部切除中的可行性和安全性及短期预后。方法:本研究前瞻性地收集自2015年12月至2016年12月的行回盲部切除的克罗恩病患者的临床资料。他们在入院前被随机分配到快速康复组和传统治疗组,快速康复组的围手术期处理包括:术前晚不常规禁食、术前不做肠道准备、术后不放置腹腔引流管、早期拔出导尿管、早期饮食及下床活动、围手术期间控制性补液等。该研究在美国临床试验数据库(ClinicalTrials.gov)注册,注册号为NCT02777034。收集临床数据,比较两组间术后排气时间、术后并发症、术后住院时间、术后住院费用等之间的差异。结果:符合标准的患者总共32位,男性20例,女性12例,平均年龄30.5岁。这32位患者均确诊为克罗恩病,且病变部位均位于回盲肠。快速康复和传统治疗两组间的术前资料,如年龄、病程、体质指数(BMI)、白蛋白(ALB)、C-反应蛋白(CRP)、血沉(ESR)、吸烟史、用药史等无明显差异(p0.05)。而术后排气时间(1.75±0.58天vs 3.13±0.89天,p=0),术后住院时间(5.19±1.28天vs 9.94±3.33 天,p=0),术后住院费用(2.70±0.50 万元 vs3.73±0.75 万元,p=0),等差异较显著,均有统计学意义;但是术后并发症(2例vs 2例)两组间无明显差异(p=1)。结论:腹腔镜联合快速康复外科治疗可以改善克罗恩病回盲部切除患者的术后短期结局。
[Abstract]:Background: (ERAS) has been successfully applied in general surgery, cardiac surgery, orthopedics and gynecology in recent years. Especially in the field of colorectal neoplasms, laparoscopy combined with rapid rehabilitation surgery has been widely recognized. Because of the characteristic of Crohn's disease and the high complication of operation, laparoscopy combined with rapid rehabilitation surgery has not been widely used in the surgical treatment of Crohn's disease. Objective: to investigate the feasibility, safety and short-term prognosis of laparoscopy combined with rapid rehabilitation surgery in ileocecal resection of Crohn's disease. Methods: the clinical data of Crohn's disease patients undergoing ileocecal resection from December 2015 to December 2016 were collected prospectively. They were randomly assigned to the fast rehabilitation group and the traditional treatment group before admission. The perioperative management of the fast rehabilitation group included: no routine fasting at night before surgery, no bowel preparation before operation, no abdominal drainage tube after surgery, and early extraction of the catheter. Early diet and activities out of bed, perioperative controlled fluid rehydration, etc. The study is registered with the US Clinical trial Database (ClinicalTrials.gov), registration number NCT02777034. The clinical data were collected to compare the differences of postoperative exhaust time postoperative complications postoperative hospitalization time and postoperative hospitalization cost between the two groups. Results: a total of 32 patients, 20 males and 12 females, met the criteria with an average age of 30.5 years. All of the 32 patients were diagnosed with Crohn's disease and the lesions were located in the ileocecum. There was no significant difference in preoperative data, such as age, course of disease, body mass index (BMI),) albumin (ALB), (ALB), C-reactive protein (CRP),) erythrocyte sedimentation rate (ESR), history of medication between the two groups (p0.05). However, the postoperative exhaust time (1.75 卤0.58 days, vs 3.13 卤0.89 days, p0), postoperative hospitalization time (5.19 卤1.28 days, vs 9.94 卤3.33 days, p0), postoperative hospitalization cost (2.70 卤5000 vs3.73 卤7500 yuan, p0); The difference was statistically significant. However, there was no significant difference in postoperative complications (2 cases of vs, 2 cases) between the two groups (p1). Conclusion: laparoscopy combined with rapid rehabilitation surgery can improve the short-term outcome of patients with Crohn's disease after ileocecal resection.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.9

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