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择期开放性左半结肠癌手术中强化康复计划与传统围手术期护理的早期结果:80例分析

Early Outcome of Enhanced Recovery Programs Versus Conventional Perioperative Care in Elective Open Left Side Colonic Carcinoma Surgery: Analysis of 80 Cases.

作者信息

Abd ElRahman Emad M, Kharoub Mohamed S, Shora Ahmed, Emara Nabil A, Balbaa M Ashraf

机构信息

General Surgery Department, Faculty of Medicine, Benha University, Benha, Egypt.

General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

Indian J Surg Oncol. 2020 Sep;11(3):372-377. doi: 10.1007/s13193-020-01074-x. Epub 2020 Apr 22.

DOI:10.1007/s13193-020-01074-x
PMID:33013113
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7501360/
Abstract

According to recent clinical practice guidelines, enhanced recovery programs (ERP) have been practiced to improve surgical outcomes and decrease cost. However, these are still opposed by the traditional measures in the treatment of colorectal carcinoma that is still practiced with the concept of protection of anastomosis and decrease postoperative complications. The aim of this study was to report our experience in ERP in elective open left side colonic carcinoma surgery in comparison with the conventional perioperative care. The current prospective multicenter randomized controlled study included a total of 80 adult patients with left side colonic cancer who were eligible for elective colonic resection. Included patients were randomly divided into two equal groups: group (A) where conventional perioperative care was performed and group (B) where ERP were applied. Follow-up was designed for at least 1 month to evaluate and compare hospital stay and postoperative complications. There was no statistically significant difference between the two groups as regards demographic data and preoperative comorbidities. There were statistically significant less pain ( = 0.24), less postoperative nausea and vomiting ( = 0.045), and less hospital stay ( < 0.001) in group B than group A. Otherwise, there was no statistically significant difference in comparing the rest of postoperative surgical or non-surgical complications or rates of readmissions between the two groups. ERP are safe, reliable, simple, and applicable in open left side cancer colon surgery with no negative impact over the postoperative complications in comparison with the conventional care.

摘要

根据最近的临床实践指南,已实施强化康复计划(ERP)以改善手术效果并降低成本。然而,这些措施仍遭到在结直肠癌治疗中仍采用保护吻合口概念并减少术后并发症的传统措施的反对。本研究的目的是报告我们在择期开放性左侧结肠癌手术中实施ERP的经验,并与传统围手术期护理进行比较。当前的前瞻性多中心随机对照研究共纳入了80例符合择期结肠切除术条件的成年左侧结肠癌患者。纳入的患者被随机分为两组:A组接受传统围手术期护理,B组应用ERP。随访设计至少1个月,以评估和比较住院时间和术后并发症。两组在人口统计学数据和术前合并症方面无统计学显著差异。B组的疼痛(P = 0.24)、术后恶心和呕吐(P = 0.045)以及住院时间(P < 0.001)均显著少于A组。否则,在比较两组术后手术或非手术并发症的其他方面或再入院率时,无统计学显著差异。与传统护理相比,ERP在开放性左侧结肠癌手术中安全、可靠、简单且适用,对术后并发症无负面影响。

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本文引用的文献

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Laparoscopic Surgery Within an Enhanced Recovery after Surgery (ERAS) Protocol Reduced Postoperative Ileus by Increasing Postoperative Treg Levels in Patients with Right-Side Colon Carcinoma.腹腔镜手术联合加速康复外科(ERAS)方案通过增加右半结肠癌患者术后 Treg 水平减少术后肠梗阻。
Med Sci Monit. 2018 Oct 10;24:7231-7237. doi: 10.12659/MSM.910817.
2
Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program: Experience with 200 cases from a single Italian center.腹腔镜结直肠手术与术后加速康复(ERAS)计划:来自意大利单一中心的200例经验
Medicine (Baltimore). 2018 Aug;97(35):e12137. doi: 10.1097/MD.0000000000012137.
3
Is the Location of the Tumor Another Prognostic Factor for Patients With Colon Cancer?肿瘤位置是结肠癌患者的另一个预后因素吗?
Ann Coloproctol. 2017 Dec;33(6):210-218. doi: 10.3393/ac.2017.33.6.210. Epub 2017 Dec 31.
4
Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons.美国结直肠外科医师协会和美国胃肠与内镜外科医师协会发布的《结肠直肠手术后加速康复临床实践指南》
Dis Colon Rectum. 2017 Aug;60(8):761-784. doi: 10.1097/DCR.0000000000000883.
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