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手术后加速康复计划联合单孔腹腔镜手术在结直肠癌手术中的比较效果:一项回顾性分析

Comparative Effectiveness of Enhanced Recovery After Surgery Program Combined With Single-Incision Laparoscopic Surgery in Colorectal Cancer Surgery: A Retrospective Analysis.

作者信息

Wang Changgang, Feng Haoran, Zhu Xiaoning, Song Zijia, Li You, Shi Yiqing, Jiang Yimei, Chen Xianze, Zhang Tao, Zhao Ren, Liu Kun

机构信息

Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Department of Neurology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Front Oncol. 2022 Jan 12;11:768299. doi: 10.3389/fonc.2021.768299. eCollection 2021.

Abstract

BACKGROUND

Recently, enhanced recovery after surgery (ERAS) has been widely used in the perioperative management of colorectal cancer (CRC). This study aimed to evaluate the safety and feasibility of ERAS combined with single-incision laparoscopic surgery (SILS) in CRC surgery.

METHODS

This was a retrospective study of patients with CRC who underwent surgery between April 2018 and April 2020 in Ruijin Hospital(North), Shanghai Jiaotong University School of Medicine. The patients were divided into three groups: group A (n=138), patients who underwent traditional multiport laparoscopic colectomy with conventional perioperative management; group B (n=63), patients who underwent SILS; and group C (n=51), patients who underwent SILS with ERAS.

RESULTS

Overall, 252 participants were included in the retrospective study. The median operation time (min) in group B and group C was shorter than that in group A (group A 134.0 ± 42.5; group B 117 ± 38.9; group C 111.7 ± 35.4, p=0.004). The estimated surgical blood loss (ml) was lower in groups B and C than in group A (group A 165.1 ± 142.2; group B 122.0 ± 79.4; group C 105.2 ± 55.8, p=0.011). The length of surgical incision (cm) was shorter in groups B and C than in group A (group A 7.34 ± 1.05; group B 5.60 ± 0.80; group C 5.28 ± 0.52, p<0.001). The time before first flatus (hours) in group C was shorter than in groups A and B (group A 61.85 ± 21.14; group B 58.30 ± 20.08; group C 42.06 ± 23.72; p<0.001). The days prior to the administration of free oral fluids in group C was shorter than in groups A and B (group A 4.79 ± 1.28; group B 4.67 ± 1.11; group C 2.62 ± 0.64; p<0.001). The days of prior solid diet was less in group C than in groups A and B (group A 7.22 ± 3.87; group B 7.08 ± 3.18; group C 5.75 ± 1.70; p=0.027). The postoperative length of stay (LOS) was less in group C compared with that in groups A and B (group A 9.46 ± 4.84 days; group B 9.52 ± 7.45 days; group C 7.20 ± 2.37 days; p=0.023). The visual analog scale (VAS) scores on day 0, 1, and 2 in groups B and C were lower than those in group A (day 0, p<0.001; day 1, p<0.001; day 2, p=0.002), while the VAS score on day 3 showed no differences in the three groups (group A 1.29 ± 1.38; group B 0.98 ± 1.24; group C 0.75 ± 0.64, p=0.018).

CONCLUSION

The findings suggest that SILS combined with ERAS may be a feasible and safe procedure for CRC surgery because it provides favorable cosmetic results, early dietary resumption, shorter hospital stays, and appropriate control of postoperative pain without increases in complications or readmission rates compared to conventional perioperative care with SILS or conventional laparoscopic surgery(CLS) of CRC. Further prospective randomized controlled studies are needed to enhance evidence-based medical evidence.

摘要

背景

近年来,术后加速康复(ERAS)已广泛应用于结直肠癌(CRC)的围手术期管理。本研究旨在评估ERAS联合单孔腹腔镜手术(SILS)在CRC手术中的安全性和可行性。

方法

这是一项对2018年4月至2020年4月在上海交通大学医学院附属瑞金医院(北院)接受手术的CRC患者的回顾性研究。患者分为三组:A组(n = 138),接受传统多孔腹腔镜结肠切除术及传统围手术期管理的患者;B组(n = 63),接受SILS的患者;C组(n = 51),接受SILS联合ERAS的患者。

结果

总体而言,252名参与者纳入了这项回顾性研究。B组和C组的中位手术时间(分钟)短于A组(A组134.0±42.5;B组117±38.9;C组111.7±35.4,p = 0.004)。B组和C组的估计手术失血量(毫升)低于A组(A组165.1±142.2;B组122.0±79.4;C组105.2±55.8,p = 0.011)。B组和C组的手术切口长度(厘米)短于A组(A组7.34±1.05;B组5.60±0.80;C组5.28±0.52,p<0.001)。C组首次排气时间(小时)短于A组和B组(A组61.85±21.14;B组58.30±20.08;C组42.06±23.72;p<0.001)。C组开始自由口服液体的天数短于A组和B组(A组4.79±1.28;B组4.67±1.11;C组2.62±0.64;p<0.001)。C组开始固体饮食的天数少于A组和B组(A组7.22±3.87;B组7.08±3.18;C组5.75±1.70;p = 0.027)。C组术后住院时间(LOS)少于A组和B组(A组9.46±4.84天;B组9.5(2)±7.45天;C组7.20±2.37天;p = 0.023)。B组和C组术后第0、1和2天的视觉模拟评分(VAS)低于A组(第0天,p<0.001;第1天,p<0.001;第2天,p = 0.002),而三组术后第3天的VAS评分无差异(A组1.29±1.38;B组0.98±1.24;C组0.75±0.64,p = 0.018)。

结论

研究结果表明,SILS联合ERAS对于CRC手术可能是一种可行且安全的术式,因为与CRC的SILS或传统腹腔镜手术(CLS)的传统围手术期护理相比,它能提供良好的美容效果、早期饮食恢复、缩短住院时间,并能适当控制术后疼痛,且不增加并发症或再入院率。需要进一步进行前瞻性随机对照研究以加强循证医学证据。

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