Mari Giulio, Costanzi Andrea, Crippa Jacopo, Falbo Rosanna, Miranda Angelo, Rossi Michele, Berardi Valter, Maggioni Dario
Chirurgia (Bucur). 2016 Nov-Dec;111(6):476-480. doi: 10.21614/chirurgia.111.6.476.
ERAS program applied to colorectal laparoscopic surgery is well known to reduce hospitalization improving short terms outcomes and minimizing the Surgical Stress Response. However its effectiveness in elderly population is yet to be demonstrated. The primary aim of this study is to compare the level of immune and nutritional serum indexes across surgery in patients aged over 70 years old undergoing elective colorectal laparoscopic surgery within an ERAS protocol or according to a Standard program. 83 patients undergoing colorectal laparoscopic surgery were enrolled and randomized in two groups (ERAS Group 40, Standard Group 43) within a larger randomized trial on a general population. Surgical stress parameters were collected preoperatively, 1, 3 and 5 days after surgery. Nutritional parameters were collected preoperatively, 1 and 5 days after surgery. Short Term Outcomes were also prospectively assessed. IL-6 levels were lower in the EG on 1, 3, and 5 days post-operatively (p 0.05). IL-6 levels in the Enhanced group returned to pre operative level 3 days after surgery. C-reactive protein level was lower in the Enhanced group on day 1, 3, and 5 (p 0.05). There was no difference in Cortisol and Prolactin levels between groups. Prealbumin serum level was higher on day 5 (p 0.05) compared to standard group. Postoperative outcomes in terms of normal bowel function and length of hospital stay were significantly improved in the ERAS group. Colorectal laparoscopic surgery within an ERAS prototcol in elderly patients affects Surgical Stress Response, decreasing IL-6 and CRP levels postoperatively and improving Prealbumin post operative synthesis.
众所周知，应用于结直肠腹腔镜手术的加速康复外科（ERAS）方案可减少住院时间，改善短期预后并将手术应激反应降至最低。然而，其在老年人群中的有效性尚待证实。本研究的主要目的是比较在ERAS方案或标准方案下，70岁以上接受择期结直肠腹腔镜手术患者手术过程中的免疫和营养血清指标水平。83例接受结直肠腹腔镜手术的患者在一项针对普通人群的更大规模随机试验中被纳入并随机分为两组（ERAS组40例，标准组43例）。在术前、术后1天、3天和5天收集手术应激参数。在术前、术后1天和5天收集营养参数。还对短期预后进行了前瞻性评估。术后第1天、3天和5天，ERAS组的IL-6水平较低（p<0.05）。ERAS组术后3天IL-6水平恢复到术前水平。ERAS组术后第1天、3天和5天的C反应蛋白水平较低（p<0.05）。两组间皮质醇和催乳素水平无差异。与标准组相比，ERAS组术后第5天的血清前白蛋白水平较高（p<0.05）。ERAS组在正常肠功能和住院时间方面的术后预后显著改善。老年患者采用ERAS方案进行结直肠腹腔镜手术可影响手术应激反应，降低术后IL-6和CRP水平，并改善术后前白蛋白的合成。
