快速康复外科理念在结直肠癌围手术期应用的临床研究

发布时间：2018-07-26 12:26

【摘要】：目的:研究快速康复外科理念在结直肠癌围手术期中的应用效果,并探讨其在地市级医院结直肠癌手术中广泛开展的可行性。方法:根据入组条件收集2015年1月-2015年12月本院收治的62例行结直肠癌根治手术患者的临床资料,根据围手术期处置方式的不同分为快速康复组(n=30)和传统处置组(n=32),对两组患者的临床资料进行非随机对照研究,比较两组患者年龄、性别、肿瘤部位、合并的基础疾病、肿瘤TNM分期、麻醉ASA评分、营养评分、术中情况(术中出血、手术时间)、术后恢复情况(首次排气和排便时间,疼痛NRS评分为0分所用时间)、术后并发症发生率(吻合口瘘、肺部感染、心功能障碍、下肢深静脉血栓、刀口感染、尿潴留、泌尿系统感染、术后肠梗阻、腹胀等)、住院时间、住院费用、临床常用检验指标(手术前后外周血白细胞计数、C-反应蛋白、总蛋白、白蛋白),以及患者住院期间满意度等指标。结果:1.快速康复组与传统处置组患者在年龄、性别、肿瘤部位、合并的基础疾病、肿瘤TNM分期、麻醉ASA评分、营养评分、术中出血量、手术时间方面无显著差异性(P0.05),两组患者具有可比性。2.快速康复组患者术后首次排气时间为63.33±7.88min、首次排便时间为84.17±8.21min、疼痛NRS评分为0所用时间为3.82±0.66d、住院时间为11.63±2.16d,传统处置组患者术后首次排气时间为97.19±11.38min、首次排便时间为126.59±15.34min、疼痛NRS评分为0所用时间为5.36±1.02d、住院时间为16.03±1.18d,快速康复组患者术后首次排气时间、首次排便时间、疼痛nrs评分为0所用时间及住院时间明显短于传统处置组,差异均有统计学意义(p0.05)。两组患者住院费用分别为2.42±0.32万、3.19±0.22万,快速康复组显著低于传统处置组,差异具有统计学意义(p0.05)。快速康复组患者术后并发症发生率为13.3%(4/30)低于传统处置组28.1%(9/32),但差异无统计学意义(p0.05)。快速康复组术后第1天外周血白细胞计数为9.78±1.98×109/l、cpr为41.57±17.78mg/l,传统处置组术后第1天外周血白细胞计数为12.79±1.98×109/l、cpr为97.22±29.79mg/l,与传统处置组相比快速康复组患者术后白细胞计数、cpr水平更低,差异具有统计学意义(p0.05),快速康复组患者术后炎症反应更小。快速康复组术后第1天tp、alb分别为71.75±3.62g/l、38.99±2.49g/l,传统处置组术后第1天tp、alb分别为69.66±3.41g/l、36.89±3.34g/l,快速康复组患者术中血清蛋白丢失量更少,差异具有统计学意义(p0.05)。3.快速康复组患者住院期间治疗满意率为93.3%(28/30),传统处置组患者治疗满意率为71.8%(23/32),快速康复组患者对治疗满意度明显高于传统处置组,差异具有统计学意义(p0.05)。结论:1.快速康复外科理念应用于结直肠癌围手术期可显著缩短患者术后胃肠道功能恢复时间,减轻术后疼痛,术后平均住院时间明显缩短,医疗费用有所减少,且不会增加术后吻合口瘘、刀口感染、术后肠梗阻等并发症的发生率。2.快速康复外科理念在结直肠癌围手术期中应用可降低患者术后炎症反应,手术过程中血清蛋白的丢失量更少,患者术后营养状态更好,患者满意度较高。3.快速康复外科理念在结直肠癌围手术期应用是安全、有效的。4.快速康复外科理念在地市级医院结直肠癌手术中安全可行,可以推广应用。
[Abstract]:Objective: To study the application of the concept of rapid rehabilitation surgery in the perioperative period of colorectal cancer and to explore its feasibility in the operation of colorectal cancer in the municipal hospitals. Methods: according to the conditions of the group, 62 patients with radical resection of colorectal cancer in December January 2015 -2015 were collected and the clinical data were collected and according to the perioperative operation. The different treatment methods were divided into the rapid rehabilitation group (n=30) and the traditional treatment group (n=32). The clinical data of the two groups were studied in a nonrandomized controlled study. The age, sex, site of the tumor, the underlying disease, the TNM staging of the tumor, the ASA score, the nutritional score, the intraoperative bleeding, the operation time and the postoperative recovery were compared. Conditions (first exhaust and defecation time, pain NRS score for 0 minutes), postoperative complications (anastomotic fistula, pulmonary infection, heart dysfunction, deep venous thrombosis of the lower extremities, knife mouth infection, urinary retention, urinary tract infection, postoperative intestinal obstruction, abdominal distention, etc.), hospitalization time, hospitalization expenses, and clinical test index (peripheral and before and after surgery) Blood leucocyte count, C- reactive protein, total protein, albumin, and patient satisfaction during hospitalization. Results there was no significant difference in age, sex, tumor site, combined basic disease, TNM staging, anesthesia ASA score, nutritional score, intraoperative bleeding, and operation time between the 1. rapid rehabilitation group and the traditional treatment group (P0. 05) the first exhaust time of the two groups was 63.33 + 7.88min, the first defecation time was 84.17 + 8.21min, the pain NRS score was 0, the time was 3.82 + 0.66d, the time of hospitalization was 11.63 + 2.16d, the first gas exhausting time of the traditional treatment group was 97.19 + 11.38min, and the first defecation time was 126.59 The pain NRS score was 0, the time was 5.36 + 1.02d and the hospitalization time was 16.03 + 1.18d. The first exhaust time of the patients in the rapid rehabilitation group, the first defecation time, the pain NRS score of 0 were significantly shorter than the traditional treatment group, and the difference was statistically significant (P0.05). The hospitalization expenses of the two groups were 2.42 + 0, respectively. .32 million, 3.19 + 2 thousand and 200, rapid rehabilitation group was significantly lower than the traditional treatment group, the difference was statistically significant (P0.05). The incidence of postoperative complications in the rapid rehabilitation group was 13.3% (4/30) lower than that of the traditional treatment group (9/32), but the difference was not statistically significant (P0.05). The white blood cell count in the fast recovery group was 9.78 + 1.98 * 109/l after first days after the operation. CPR was 41.57 + 17.78mg/l. The white blood cell count of the peripheral blood in the traditional treatment group was 12.79 + 1.98 x 109/l after first days, and CPR was 97.22 + 29.79mg/l. Compared with the traditional treatment group, the leukocyte count and the CPR level were lower in the rapid rehabilitation group. The difference was statistically significant (P0.05). The rapid rehabilitation group had less inflammatory response after operation. First days after the operation, TP, ALB was 71.75 + 3.62g/l, 38.99 + 2.49g/l respectively. The traditional treatment group was 69.66 + 3.41g/l, 36.89 + 3.34g/l after first days of operation, and the loss of serum protein was less in the rapid rehabilitation group (P0.05), the difference was statistically significant (P0.05) in the rapid rehabilitation group, the treatment satisfaction rate was 93.3% (28/30) and the traditional treatment was 93.3% (28/30). The satisfaction rate of the patients in the group was 71.8% (23/32). The satisfaction of the patients in the rapid rehabilitation group was significantly higher than that of the traditional treatment group. The difference was statistically significant (P0.05). Conclusion: the application of the concept of 1. rapid rehabilitation surgery to the perioperative period of colorectal cancer can significantly shorten the recovery time of the gastrointestinal function after operation, reduce postoperative pain, and live on average after operation. The hospital time is obviously shortened, the medical cost is reduced, and the postoperative complications such as anastomotic fistula, knife mouth infection, postoperative intestinal obstruction, and other complications,.2. rapid rehabilitation surgery concept can reduce the postoperative inflammatory reaction in the perioperative period of colorectal cancer, the loss of serum protein in the operation process is less, and the postoperative nutritional status of the patients. The concept of.3. rapid rehabilitation surgery is safe in the perioperative period of colorectal cancer. The effective.4. rapid rehabilitation surgery concept is safe and feasible in the operation of colorectal cancer in the city level hospital and can be popularized.
【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.34

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