[结肠手术的快速康复：一项前瞻性试验的结果]

[Fast track rehabilitation in colonic surgery: results of a prospective trial].

作者信息

Proske J M, Raue W, Neudecker J, Müller J M, Schwenk W

机构信息

Service de chirurgie générale, digestive, vasculaire et thoracique, Charité-Campus-Mitte, Humboldt Universität, Berlin, Allemagne.

出版信息

Ann Chir. 2005 Mar;130(3):152-6. doi: 10.1016/j.anchir.2004.12.012. Epub 2005 Jan 21.

DOI:10.1016/j.anchir.2004.12.012

PMID:15784217

Abstract

OBJECTIVE

In elective large bowel surgery the incidence of general complications with standard perioperative care is up to 27%. Hospital discharge occurs 10 to 15 days after a conventional or laparoscopic colonic resection. The aim of a fast track management is to reduce the number of general complications and the length of hospital stay.

MATERIAL AND METHODS

We prospectively evaluated a multimodal protocol in our service utilizing a combined thoracic epidural analgesia, an early mobilization and oral nutrition to accelerate postoperative recovery after elective colonic surgery.

RESULTS

One hundred thirty-two consecutive patients aged an average of 66 years (range 22-88) were operated by laparotomy (n =71) or laparoscopy (n =61) and treated with the fast track rehabilitation protocol. Surgical complications occurred in 15 patients (11 %), four of these had an anastomotique leakage (3%). General complications occurred in 11 patients (8 %), the mortality was 1 %. The median length of hospital stay was four days (range 3-77) and 14 patients (11%) had to be readmitted.

CONCLUSION

Application of a fast track rehabilitation protocol lowered the number of general complications and reduced the duration of hospital stay in our study.

摘要

目的

在择期大肠手术中，采用标准围手术期护理时，一般并发症的发生率高达27%。传统或腹腔镜结肠切除术后10至15天出院。快速康复管理的目的是减少一般并发症的数量和缩短住院时间。

材料与方法

我们前瞻性地评估了我院采用胸段硬膜外联合镇痛、早期活动及口服营养的多模式方案，以加速择期结肠手术后的恢复。

结果

连续132例平均年龄66岁（范围22 - 88岁）的患者接受了开腹手术（n = 71）或腹腔镜手术（n = 61），并采用快速康复方案进行治疗。15例患者（11%）发生手术并发症，其中4例出现吻合口漏（3%）。11例患者（8%）发生一般并发症，死亡率为1%。中位住院时间为4天（范围3 - 77天），14例患者（11%）需再次入院。