标题：加速康复外科理念对老年远端胃癌根治术后恢复的影响

      作者：姜艳辉，江爱宗，王冰    辽河油田总医院胃肠外科，辽宁 盘锦 124010

      卷次： 2019年30卷3期

      【摘要】 目的 观察加速康复外科(ERAS)理念在老年患者行远端胃癌根治术中应用的安全性及可行性。方法 回顾性分析辽河油田总医院胃肠外科2016年1月至2018年4月收治的80例行远端胃癌根治手术的老年胃癌患者临床资料，其中40例围手术期应用ERAS理念处理(ERAS组)，另外40例应用传统围手术期理念处理(传统组)。比较两组患者的手术时间、术中总出血量、术后肛门排气时间、首次进食流食时间、术后下床时间、住院时间、住院费用和手术并发症发生情况，以及术前术后血清白蛋白及炎症反映指标C-反应蛋白(CRP)和白细胞介素-6(IL-6)的检测结果。结果 ERAS组患者术后肛门排气时间、首次进食流食时间、术后下床时间、术后住院时间及住院费用均较传统组减少，差异均有统计学意义(P<0.05)；但两组患者的手术时间和术中总出血量比较差异均无统计学意义(P>0.05)；两组患者在肺部感染、吻合口瘘、吻合口出血、腹腔感染、切口感染、胃瘫、恶心呕吐、腹胀、肠梗阻、泌尿系感染方面比较差异均无统计学意义 (P>0.05)；ERAS组患者术后总并发症发生率为 20.0% (8/40)，明显低于传统组的50.0% (20/40)，差异有统计学意义(P<0.05)；传统组患者术后第 5天白蛋白水平为(34.87±2.97) g/L，明显低于ERAS组的(36.73±3.53) g/L，差异有统计学意义(P<0.05)；术后第 3日和第 5日，ERAS组患者的C-反应蛋白分别为(76.56±19.04) mg/L、(47.78±16.14) mg/L，明显低于传统组的(91.37±21.30) mg/L和(60.43±18.16) mg/L，差异均有统计学意义(P<0.05)；术后第 3天和第 5天，ERAS组患者的白细胞介素-6分别为(187.52±16.75) ng/L、137.52±19.73 ng/L，明显低于传统组的(213.34±24.81) ng/L、(166.8±23.56) ng/L，差异均具有统计学意义(P<0.05)。结论 ERAS理念应用于老年患者行远端胃癌根治性手术是安全、可行的。
      【关键词】 加速康复外科；胃癌；远端；胃切除术；围手术期；并发症
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2019）03— 290—04

Effect of enhanced recovery after surgery on the postoperative recovery of elderly patients with distal gastriccancer after radical gastrectomy.
JIANG Yan-hui, JIANG AI-zong, WANG Bing. Department of Gastrointestinal Surgery,Liaohe Oilfield General Hospital, Panjin 124010, Laoning, CHINA
【Abstract】 Objective To observe the safety and feasibility of the application of the enhanced recovery aftersurgery (ERAS) in the radical operation of distal gastric cancer in elderly patients. Methods The clinical data of elder-ly patients with gastric cancer treated by radical gastrectomy in the Department of Gastrointestinal Surgery, Liaohe Oil-field General Hospital from January 2016 to April 2018 were analyzed retrospectively, which were treated by ERAS con-cept (40 patients, ERAS group) or traditional concept during the perioperative period (40 patients, traditional group).The operation time, total intraoperative bleeding, anal exhaust time, first feeding time, time to get out of bed, hospitaliza-tion time, hospitalization expenses, and complications were compared between the two groups, and the detection resultsof serum albumin and inflammation indexes including C-reactive protein (CRP) and interleukin-6 (IL-6) were com-pared before and after operation. Results The postoperative anal exhaust time, first feeding time, time to get out ofbed, the postoperative hospitalization time, and the hospitalization expenses of the ERAS group were reduced comparedwith those in the traditional group, and the differences were statistically significant (P<0.05). There was no significantdifference between the two groups in terms of operation time and total intraoperative bleeding (P>0.05). There wereno statistically significant differences between the two groups in pulmonary infection, anastomotic fistula, anastomotichemorrhage, abdominal infection, incision infection, gastroparesis, nausea and vomiting, abdominal distension, intes-tinal obstruction, and urinary tract infection (P>0.05). The total incidence of postoperative complications was 20.0%(8/40) in ERAS group, significantly lower than 50.0% (20/40) in traditional group (P<0.05). In the traditional group, thelevel of albumin was (34.87±2.97) g/L on the 5th day after operation, which was significantly lower than (36.73±3.53) g/Lin the ERAS group (P<0.05). The level of CRP in the ERAS group was (76.56 ± 19.04) mg/L on the 3rd day and(47.78±16.14) mg/L on the 5th day, which was significantly lower than (91.37±21.30) mg/L and (60.43±18.16) mg/L inthe traditional group (P<0.05). The level of IL-6 in the ERAS group was (187.52 ± 16.75) ng/L on the 3rd day and(137.52±19.73) ng/L on the 5th day after operation, which was significantly lower than (213.34±24.81) ng/L and (166.8±23.56) ng/L in the traditional group (P<0.05). Conclusion ERAS is safe and feasible for elderly patients with distal gas-tric cancer undergoing radical gastrectomy.
      【Key words】 Enhanced recovery after surgery (ERAS); Gastric cancer; Distal