快速康复外科对胃癌患者术后炎性反应及并发症的影响

发布时间：2018-01-16 19:19

  本文关键词：快速康复外科对胃癌患者术后炎性反应及并发症的影响　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 快速康复外科 胃癌 炎症反应 并发症

【摘要】：目的:观察采用快速康复外科治疗(fast track surgery,FTS)对不同年龄段胃癌患者术后炎症及并发症的影响,探讨其促进患者术后快速康复的机制及临床价值。方法:选择经纤维胃镜及腹部CT检查结果确诊的胃癌患者126例作为病例组,制定纳入标准和排除标准,根据年龄段分为小于等于64岁患者(63例)和大于等于65岁患者(63例)两大组,再对每一大组根据治疗方法不同分为快速康复治疗组(FTS,实验组)和传统治疗组(CC,对照组),即小于等于64岁患者组为快速康复治疗组(FTS-1,32例)和传统治疗组(CC-1,31例),大于等于65岁患者组为快速康复治疗组(FTS-2,31例)和传统治疗组(CC-2,32例)。对所有入组患者分别在手术前1天、术后1天及术后3天进行抽取静脉血,通过双抗体夹心ELISA法检测血清中IL-6、IL-10及TNF-α浓度,采用上转发光免疫层析定量检测PCT血清浓度。利用SPSS19.0数据统计学软件处理分析,检验水准以a=0.05为标准。结果:不同年龄段患者的一般资料特征比较,包括年龄,性别,手术时间,ASA评分,手术类型,重建类型,肿瘤TNM分期阶段、合并症(高血压病、心血管疾病、肺部疾病、糖尿病、肾脏疾病)(这些指标P0.05),然而,除不同年龄段患者的年龄之间有差异(P0.05,),四组患者其他任何特征均无差异。不同年龄段在快速康复外科组术后1天、3天的血清PCT与促炎症因子IL-6和TNF-α水平升高幅度低于同期传统治疗组,而血清抗炎症因子IL-10水平升高幅度高于同期传统治疗组(P0.05)。术后临床观察恢复情况为:1)在快速康复外科组术后首次排气时间和术后住院时间明显缩短分别为[(3.2±0.6和3.5±0.5,P=0.021)和(6.2±1.4和10.0±2.2,p=0.000)],然而,研究表明fts-2和cc-2组之间无显著性差异,其分别为[(3.4±0.3和3.6±0.3,p=0.053)和(10.1±1.5和10.8±1.2,p=0.056)]。2)与传统治疗组比较,使用快速康复外科组住院总费用明显降低,该组为(36.3±2.8和38.0±3.1千元,p=0.025),但在fts-2和cc-2组之间无显著性差异,该组为(40.9±1.5和41.7±1.8千元,p=0.061)。3)30天内术后再住院率在fts和cc组之间没有差异(p0.05)。术后并发症比较:1)在fts-2组术后肺部感染及泌尿道感染发生率比传统治疗组明显降低[(3/31和10/32,p=0.034),和(2/31和9/32,p=0.023)],但fts-1和cc-1组之间没有显著差异(分别为p=0.670,p=0.368和p=0.638);2)fts-1和cc-1组之间的术后恶心呕吐发生率没有差异(5/32和3/31,p=0.741),然而,在fts-2组明显增加(9/31和3/32,p=0.047);3)在快速康复外科组术后肠梗阻发生率显著降低(3/32和9/31,p=0.047),但fts-2和cc-2组之间没有显著差异(3/31和5/32,p=0.,741);4)在同一年龄段范围内,不同治疗组之间的术后并发症发生率没有显著差异(如咽喉炎、胃潴留、尿潴留、吻合口瘘、切口感染、下肢深静脉血栓形成)(全部p0.05)。结论:1.快速康复外科治疗对胃癌手术患者创伤较小,能够明显降低患者术后炎症反应。2.对于年轻胃癌手术患者("f64岁),快速康复外科治疗能够降低其术后肠梗阻发生率,缩短术后肛门排气时间及术后住院时间,减少总住院费用。3.对于老年胃癌手术患者("g65岁),快速康复外科治疗能够降低其术后恶心呕吐、肺部感染及尿道感染发生率,而对术后肛门排气时间、术后住院时间及总住院费用没有影响。4.快速康复外科治疗对胃癌患者术后的咽喉炎、胃潴留、吻合口漏、尿潴留、切口感染及下肢静脉血栓形成及再次住院人数并没有影响。
[Abstract]:Objective: To observe the use of rapid rehabilitation surgical treatment (fast track surgery, FTS) of different ages of patients with gastric cancer and inflammatory complications, explore the clinical value and its mechanism for patients with rapid rehabilitation. Methods: by endoscopy and abdominal CT examination results of 126 gastric cancer patients diagnosed as cases formulation, inclusion criteria and exclusion criteria, according to the age is less than or equal to 64 year old patients (63 cases) and greater than or equal to 65 year old patients (63 cases) two groups, then each group according to the different treatment methods for the rapid rehabilitation treatment group (FTS, experimental group and conventional treatment group (CC) that is less than or equal to the control group), 64 year old patient group for the rapid rehabilitation treatment group (FTS-1,32 cases) and conventional treatment group (CC-1,31 cases), greater than or equal to 65 patients for the rapid rehabilitation treatment group (FTS-2,31 cases) and conventional treatment group (CC-2,32 cases). All patients were divided into the group of Don't 1 days before surgery, after 1 days and 3 days after operation for venous blood serum was detected by IL-6 double antibody sandwich ELISA method, IL-10 and TNF- concentrations, turn light PCT serum concentrations measured by quantitative immunochromatography. Using statistical analysis software SPSS19.0 data processing, inspection level a=0.05 standard. Results: compared with general information, characteristics of patients with different ages including age, gender, operation time, ASA score, type of surgery, reconstruction type, TNM stage of the tumor stage, comorbidities (hypertension, cardiovascular disease, lung disease, diabetes, kidney disease (P0.05) of these indicators, however, except between patients) different age age difference (P0.05), there was no difference between the four groups in any other characteristics. Different ages in fast track surgery group after 1 days, 3 days of serum PCT and pro inflammatory factors IL-6 and TNF- levels significantly lower than the same period 浼犵粺娌荤枟缁，

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