|
|
|
| Effect of fast track surgery concept on postoperative rehabilitation and perioperative stress index in patients undergoing laparoscopic radical gastrectomy |
| LI Sibo HUANG Lan▲ |
| Department of Tumor Laparoscopic Surgery, the First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150001, China |
|
|
|
Abstract Objective To explore and analyze the effect of fast track surgery (FTS) concept on postoperative rehabilitation and perioperative stress indicators in patients undergoing laparoscopic radical gastrectomy. Methods A total of 82 patients undergoing laparoscopic radical gastrectomy admitted to the First Affiliated Hospital of Harbin Medical University from June 2017 to June 2019 were selected as the research objects. A random number table method was used to divide them into the control group and observation group, each with 41 cases. The control group was given routine perioperative management, and the observation group was giren group perioperative management based on the concept of FTS on the basis of the control group. The surgical indicators (operating time, intraoperative blood loss, number of lymph node dissections, number of indwelling drainage tubes and intraoperative fluid replenishment), postoperative rehabilitation related indicators (anal exhaust time, urinary tube removal time, oral feeding time and the length of hospital stay), perioperative stress indicators [C-reactive protein (CRP) and interleukin-6 (IL-6) before operation and on the first, fourth, and seventh days after operation] and complication rate were compared between the two groups. Results There were no significant differences in the operation time, intraoperative blood loss, and number of lymph node dissection between the two groups (all P ＞ 0.05). Compared with the control group, the number of indwelling drainage tubes and the amount of intraoperative fluid replacement in the observation group were less (all P ＜ 0.01). In the observation group, the time of anal exhaust, the time of removing the urinary tube, the time of oral feeding and the length of hospital stay were shorter (all P ＜ 0.01). Compared with preoperation, the levels of CRP and IL-6 in the two groups increased significantly on the first, fourth, and seventh days after operation (all P ＜ 0.05). The levels of CRP and IL-6 in the observation group were significantly lower than those in the control group (all P ＜ 0.05). Compared with the control group, the observation group had a lower incidence of anastomotic leakage, infection, gastric retention, intestinal obstruction, and postoperative bleeding complications (all P ＜ 0.05). Conclusion Implementing the concept of FTS based on conventional perioperative management and applying the concept of laparoscopic radical gastrectomy can effectively promote the recovery of patients after surgery, improve perioperative stress indicators, and reduce the incidence of complications, ensure safety better.
|
|
|
|
|
|
[1] 贺宇彤，梁迪，李道娟，等.河北省2011年恶性肿瘤发病与死亡分析[J].中华流行病学杂志，2015，36（8）：846-851.
[2] 彭文轩，徐阿曼，陈章明，等.胃癌患者术前血清前白蛋白与临床病理特征及预后的关系[J].安徽医药，2017，21（6）：78-79.
[3] Torre LA，Bray F，Siegel RL，et al. Global cancer statistics，2012 [J]. CA Cancer J Clin，2015，65（2）：87-108.
[4] Tanaka S，Toyonaga T，Morita Y，et al. Endoscopic submucosal dissection for early gastric cancer in anastomosis site after distal gastrectomy [J]. Gastric Cancer，2014，17（2）：371-376.
[5] Son T，Hyung WJ，Lee JH，et al. Minimally invasive surgery for serosa-positive gastric cancer（pT4a）in patients with preoperative diagnosis of cancer without serosal invasion [J]. Surg Endosc，2014，28（3）：866-874.
[6] 王美清，彭大为，程小珍，等.自体免疫细胞治疗前后胃癌患者外周血免疫功能测定及临床意义[J].中国现代医学杂志，2014，24（35）：35-38.
[7] Aslan D，Grama F，Cristian D，et al. Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer-Risk Factors for Local Recurrence and Anastomotic Leakage [J]. Chirurgia：Bucur，2016，111（6）：481-486.
[8] Hellan M，Ouellette J，Lagares-Garcia JA，et al. Robotic Rectal Cancer Resection：A Retrospective Multicenter Analysis [J]. Ann Surg Oncol，2015，22（7）：2151-2158.
[9] 张海鸣，潘瑞蓉，周科军.早期谷氨酰胺强化联合百普力肠内营养支持对老年胃癌患者术后营养免疫功能及肠黏膜屏障功能的影响[J].中国现代医学杂志，2015，25（21）：107-110.
[10] 胡林，李昌荣，李伟峰，等.腹腔镜与开放全胃切除D2胃癌根治术行脾门淋巴结清扫疗效对照Meta分析[J].中国实用外科杂志，2015，10（22）：1103-1107.
[11] Torre LA，Siegel RL，Ward EM，et al. Global Cancer Incidence and Mortality Rates and Trends--An Update [J]. Cancer Epidemiol Biomarkers Prev，2016，25（1）：16-27.
[12] Fang C，Huang Q，Lu L，et al. Risk factors of early proximal gastric carcinoma in Chinese diagnosed using WHO criteria [J]. J Dig Dis，2015，16（6）：327-336.
[13] 卫洪波，魏波.全胃切除术后消化道重建术式的再探讨[J].中华胃肠外科杂志，2014，17（5）：411-415.
[14] 邹镇洪，牟廷裕，邓镇威，等.完全腹腔镜全胃切除胃癌根治术消化道重建方式的探讨[J].中华胃肠外科杂志，2014，17（8）：844-847.
[15] 季加孚，胡祥，陈凛，等.胃切除术后消化道重建技术专家共识[J].中国实用外科杂志，2014，34（3）：205-212.
[16] 刘雄友，高德山，杨晓静，等．快速康复外科理念在胃癌手术患者中的应用[J].吉林医学，2014，35（31）：690-691.
[17] 吴耀禄，曹波，白铁成，等．快速康复外科在胃癌手术中的应用现状及存在的问题[J].医学综述，2014，20（4）：644-645.
[18] 廖信芳，李柱，杨清水，等.快速康复外科对腹腔镜辅助远端胃癌根治术的应激影响[J].南昌大学学报：医学版，2016，56（2）：12-13.
[19] 张英.快速康复外科护理对腹腔镜胃癌根治术患者术后康复及短期生存质量的影响研究[J].中国实用医药，2018，13（2）：189-190.
[20] 姜玉娟，彭健，徐丽娟.快速康复外科理念在腹腔镜前列腺癌根治术中的应用[J].中西医结合护理：中英文，2019，5（4）：34-35.
[21] 邓斌.肠内营养在实施加速康复外科的老年胃癌患者中的应用效果观察[J].当代医学，2019，522（7）：33-35.
[22] 梁金玉，张娟，陈敏，等.快速康复外科理念在脊柱微创手术围手术期护理中的应用研究[J].中国医学创新，2019， 16（10）：103-107.
[23] 蔡宁，代晨旭，于海洋，等.快速康复外科理念在脊柱后凸畸形矫形术麻醉管理中的应用[J].中国医药导报，2019， 16（22）：98-102. |
|
|
|
