快速康复外科理念指导下的结直肠癌腹腔镜与开腹手术的随机对照研究

摘要

目的:比较快速康复外科(FTS)理念下结直肠癌手术中腹腔镜与开腹手术的差异,探讨FTS联合腹腔镜的必要性.方法:将2010年3月至2011年10月间广州军区广州总医院普外科收治的80例结直肠癌,随机分为两组,每组各40例,A组采用FTS联合腹腔镜手术(FTS+腹腔镜组),B组采用FTS开腹手术(FTS组),两组行随机对照研究.比较两组术后首次排气时间、排便时间、术后住院时间、住院费用等临床指标,C-反应蛋白(CRP)、白细胞介素-6(IL-6)和皮质醇等应激反应指标及术后并发症情况.结果:A组同B相比,术后首次排气时间(2.3 d vs 2.6 d)、排便时间(3.1 d vs 3.5 d)、术后住院时间(4.1 d vs 4.5 d)略有缩短,但差异均无统计学意义(P ＞ 0.05);住院费用显著增加(3.6万元 vs 2.3万元),且差异有显著统计学意义(P ＜ 0.05).两组术后第1、3天 CRP、IL-6、皮质醇等应激反应指标均明显高于术前,但两组比较差异无统计学意义(P ＞ 0.05).单个并发症及总体并发症两组比较差异无显著性(P ＞ 0.05).两组均无死亡病例.A组再入院率(1/40,2.5%)稍低于B组(2/40,5.0%),但差异无统计学意义(P ＞ 0.05).结论:腹腔镜的联合应用并不能进一步改善FTS指导下的结直肠癌术后康复进程.%Objective To investigate the essentiality of fast-track surgery (FTS) combined with laparoscopy for colorectal cancer by comparing the differences of FTS plus laparoscopy and FTS plus open surgery. Methods Eighty patients with colorectal cancer from Mar 2010 to Oct 2011 were randomized into 2 groups ,40 patients received FTS combined with laparoscopy surgery (Group A)and 40 patients received FTS combined with open abdomen surgery (Group B). The first time of flatus and defecation, the length of postoperative hospital stay , medical cost, stress index including CRP, IL-6 , cortisol, and postoperative complications were analyzed. Results As compared with those in Group B, the first time of flatus (2.3 d vs. 2.6 d) and defecation (3.1 d vs. 3.5 d), the length of hospital stay (4.1 d vs. 4.5 d) in Group A were little shorter (P > 0.05), but the medical cost [ (36 vs. 23) thousand yuan] was much more expensive (P < 0.05). Serum levels of CRP, IL-6 , cortisol at day 1 and 3 were increased after surgery (P< 0.05), but there was no significant difference between the two groups (P > 0.05). No significantly differences of single or total complications were observed between the two groups (P> 0.05). No patient died in the two groups. The rate of readmission in Group A (1/40, 2.5%) was not significantly lower than that in Group B (2/40, 5.0% ,P > 0.05). Conclusions The application of laparoscopy in FTS for colorectal cancer can not improve the postoperative rehabilitation process.