李积广,余刚
LI Jiguang,YU Gang

• 1:咸宁市中心医院湖北科技学院附属第一医院胃肠外科

摘要(Abstract)：

目的:探讨围手术期快速康复外科(FTS)联合营养风险筛查对结直肠癌患者效果的影响。方法:150例直肠癌患者随机分为Ⅰ组(传统治疗方案)、Ⅱ组(FTS方案)和Ⅲ组(营养风险筛查联合FTS方案),观察3组患者手术后首次排气和首次排便时间、术后住院天数及住院费用,比较3组患者术后恶心、呕吐、肺炎、腹胀、切口感染及吻合口瘘等并发症;检测3组患者手术当日和术后第1、3及5天的血清总蛋白、白蛋白和前白蛋白。结果:Ⅱ组与Ⅲ组患者术后首次排气和首次排便时间、住院天数及住院费用均低于Ⅰ组患者(P<0.05),Ⅲ组与Ⅱ组比较差异无统计学意义(P>0.05);3组患者术后恶心、呕吐及腹胀的发生率比较,差异无统计学意义(P>0.05);3组患者术后均未并发肺部感染,Ⅰ组和Ⅱ组患者有1例发生切口感染,Ⅰ组出现1例吻合口瘘;Ⅲ组患者术后总蛋白始终处于较高水平,术后蛋白水平下降慢,恢复快,术后第1天下降较快,术后第5天开始上升并慢慢接近术前水平,Ⅲ组患者营养状况较Ⅰ组与Ⅱ组良好(P<0.05),而Ⅱ组与Ⅰ组之间术前术后蛋白水平比较,差异无统计学意义(P>0.05)。结论:结肠癌患者围手术期行营养风险筛查联合FTS能加速患者术后胃肠功能恢复,降低住院费用与住院时间,有利于改善直肠癌患者的营养状况。
Objective:To investigate the curing effects of fast track surgery(FTS) in perioperative period of colorectal cancer and the importance of nutrition.Methods:A total of 150 patients were randomly divided into three groups; group 1(received conventional perioperative management),group2(FTS management),and group 3(FTS management plus nutritional screening).Observation was made on clinical parameters including first time to restore gastrointestinal function,length of postoperative hospital stay and hospitalization cost,nutritional status,postoperative incidences of adverse reactions and complications.Serum total protein,albumin,and prealbumin of patients in 3 groups on the day of operation and in 1,3,and 5 days after operation were tested.Results:Comparing with group1,the return of gastrointestinal function was faster,the postoperative hospital stay was shorter,and the cost was less in groups 2 and 3(P < 0.05).The differences of above indexes between group 2 and group 3 were not significant(P > 0.05).No complicated pulmonary infection occurred.There was one case of incision infection in each of group 1 and group 2,and there was one case of anastomotic fistula in group 1.The serum total protein level of patients in group 3 kept relatively high after operation.It once dropped slowly and then rised up,and closed to the level before operation in 5 days after operation.The nutrition status of patients in group 3 was obviously better than those of groups 1 and 2(P <0.05).The differences of serum protein before and after operation between group 1 and group 2 were not significant(P > 0.05).Conclusion:FTS can accelerate postoperative gastrointestinal function recovery,reduce the cost of hospitalization and the length of hospital stay of patients with colorectal cancer,and no increase of postoperative complication occurs.When combines with nutritional risk screening,the new FTS management gives patients better nutritional support,and leads to better curing results.

关键词(KeyWords)： 结直肠癌;蛋白质,血清;围手术期;快速康复外科;营养
colorectal cancer;protein;serum;perioperative period;fast track surgery;nutrition

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81172065)

作者(Author): 李积广,余刚
LI Jiguang,YU Gang

DOI: 10.19367/j.cnki.1000-2707.2017.02.017

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