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老年患者腹腔镜结直肠切除术后的强化康复计划

Enhanced recovery programme following laparoscopic colorectal resection for elderly patients.

作者信息

Zeng Wei Gen, Liu Meng Jia, Zhou Zhi Xiang, Wang Zhen Jun

机构信息

Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

出版信息

ANZ J Surg. 2018 Jun;88(6):582-586. doi: 10.1111/ans.14074. Epub 2017 Jun 22.

Abstract

BACKGROUND

The aim of this study was to investigate the feasibility and safety of an enhanced recovery programme (ERP) in patients aged ≥75 years who undergo laparoscopic surgery for colorectal cancer.

METHODS

Patients were divided into two groups according to perioperative management: the ERP group (Group A, n = 94) and the conventional perioperative care group (Group B, n = 157). The postoperative outcomes were compared between two groups.

RESULTS

There were no differences in terms of age, gender, American Society of Anesthesiologists score, operative time or blood loss between two groups. Postoperative return of gastrointestinal function was significantly faster in Group A compared to Group B, including time to first flatus (2 versus 3 days, P < 0.001), first stool (3 versus 4 days, P = 0.001) and oral intake (1 versus 4 days, P < 0.001). Group A was associated with lower overall postoperative complication rate (26.6% versus 44.6%, P = 0.004) and general complication rate (14.9% versus 31.2%, P = 0.004). The median postoperative hospital stay was 6 days in Group A and 8 days in Group B (P < 0.001), respectively.

CONCLUSIONS

ERP following laparoscopic colorectal resection for elderly patients is associated with faster postoperative recovery, shorter postoperative hospital stay and fewer complications compared with conventional perioperative care.

摘要

背景

本研究旨在探讨强化康复计划(ERP)在年龄≥75岁接受腹腔镜结直肠癌手术患者中的可行性和安全性。

方法

根据围手术期管理将患者分为两组:ERP组(A组,n = 94)和传统围手术期护理组(B组,n = 157)。比较两组术后结局。

结果

两组在年龄、性别、美国麻醉医师协会评分、手术时间或失血量方面无差异。与B组相比,A组术后胃肠功能恢复明显更快,包括首次排气时间(2天对3天,P < 0.001)、首次排便时间(3天对4天,P = 0.001)和经口进食时间(1天对4天,P < 0.001)。A组术后总体并发症发生率较低(26.6%对44.6%,P = 0.004),一般并发症发生率也较低(14.9%对31.2%,P = 0.004)。A组术后中位住院时间为6天,B组为8天(P < 0.001)。

结论

与传统围手术期护理相比,老年患者腹腔镜结直肠癌切除术后采用ERP可使术后恢复更快、住院时间更短且并发症更少。

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