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[快速康复外科在接受D2根治性胃切除术的胃癌患者中的安全性和有效性]

[The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy].

作者信息

Jiang Zhi-wei, Li Jie-shou, Wang Zhi-ming, Li Ning, Liu Xin-xin, Li Wei-yan, Zhu Si-hai, Diao Yan-qing, Nai Yong-jun, Huang Xiao-jing

机构信息

Research Institute of General Surgery, Jinling Hospital, Nanjing 210002, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2007 Oct 1;45(19):1314-7.

Abstract

OBJECTIVE

To investigate the safety and efficacy of fast track surgery (FTS) management in gastric cancer undergoing D2 gastrectomy.

METHODS

Eighty gastric cancer patients undergoing D2 gastrectomy were recruited prospectively. Patients were assigned to receive FTS management (n = 40) or conventional perioperative care (n = 40). The FTS care included shorten preoperative fasting time, no nasogastric decompressing tubes and abdominal drainage placed, early postoperative oral feeding, multimodal analgesia, and early mobilisation. The length of postoperative hospital stay, medical cost, nutritional status, gut function, and postoperative complications in the two groups were recorded and compared.

RESULTS

FTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group [(5.6 +/- 1.3) d vs. (9.4 +/- 1.9) d, P < 0.05]. Medical cost was less [(18 620 +/- 2360) Yuan vs. (20 370 +/- 2440) Yuan, P < 0.05] and duration of intravenous infusion [(3.5 +/- 1.4) d vs. (5.8 +/- 1.9) d, P < 0.05] was also shorter. First passage of flatus was earlier in FTS group than in conventional care group [(4.3 +/- 0.4) d vs. (5.5 +/- 0.9) d, P < 0.05]. Loss of body weight in the postoperative period was less in FTS group [(3.2 +/- 0.8) kg vs. (4.3 +/- 1.6) kg, P < 0.05]. There was no difference in morbidity or mortality between the two groups.

CONCLUSION

FTS in D2 gastrectomy is safe and efficient, and it can shorten postoperative hospital stay and hasten return of gut function.

摘要

目的

探讨快速康复外科(FTS)管理在接受D2根治性胃切除术的胃癌患者中的安全性和有效性。

方法

前瞻性招募80例接受D2根治性胃切除术的胃癌患者。患者被分配接受FTS管理(n = 40)或传统围手术期护理(n = 40)。FTS护理包括缩短术前禁食时间、不放置鼻胃减压管和腹腔引流管、术后早期经口进食、多模式镇痛以及早期活动。记录并比较两组患者的术后住院时间、医疗费用、营养状况、肠道功能及术后并发症。

结果

与传统护理组相比,FTS组术后住院时间显著缩短[(5.6±1.3)天 vs.(9.4±1.9)天,P < 0.05]。医疗费用更低[(18620±2360)元 vs.(20370±2440)元,P < 0.05],静脉输液时间也更短[(3.5±1.4)天 vs.(5.8±1.9)天,P < 0.05]。FTS组首次排气时间早于传统护理组[(4.3±0.4)天 vs.(5.5±0.9)天,P < 0.05]。FTS组术后体重减轻更少[(3.2±0.8)kg vs.(4.3±1.6)kg,P < 0.05]。两组患者的发病率和死亡率无差异。

结论

D2根治性胃切除术中采用FTS安全有效,可缩短术后住院时间并加速肠道功能恢复。

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