快速康复联合腹腔镜手术在结直肠癌治疗中的应用

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摘要目的：探讨快速康复联合腹腔镜手术在结直肠癌治疗中应用的可行性和优势。方法：选取温州医科大学附属第二医院肛肠外科2013年至2015年收住的69例结直肠癌患者作为观察对象，分成4组，分别是A（腹腔镜联合快速康复）组、B（开腹联合快速康复）组、C（腹腔镜联合传统康复）组、D（开腹联合传统康复）组，比较4组患者术后肠蠕动恢复时间、术后首次排气时间、术后疼痛评分、术后开始活动时间、总住院时间及围手术期血CRP浓度。结果：A组患者术后肠蠕动恢复时间、术后开始活动时间及住院总天数均明显短于其他3组，差异均有统计学意义（P＜0.05）；A组术后疼痛评分小于其他3组，差异均有统计学意义（P＜0.05）；4组患者CRP在5 d内均有不同程度回落，其中A组血CRP浓度回落幅度明显大于其他3组，差异均有统计学意义（P＜0.05）；4组患者术后肛门开始排气时间比较差异无统计学意义（P＞0.05）。结论：腹腔镜联合快速康复可以明显缩短结直肠癌患者术后肠蠕动恢复时间，减少患者住院总天数，减轻术后疼痛，能更早进行术后活动，降低手术创伤带给患者的应激反应等，在患者术后机体恢复方面有一定的优越性。

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	董殿超
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	卢敏

关键词 ：快速康复, 腹腔镜检查, 结直肠肿瘤, 临床应用

Abstract：Objective: To explore the feasibility and advantage of rapid rehabilitation combining with laparoscopic surgery in colorectal cancer. Methods: Sixty-nine cases of colorectal cancer from 2013 to 2015 in Department of Anorectal Surgery of the Second Affiliated Hospital of Wenzhou Medical University were selected as observation objects. They were divided into four groups, group A: laparoscopy combined with rapid rehabilitation group, group B: open surgery combined with rapid rehabilitation group, group C: laparoscopy combined with conventional rehabilitation group, group D: open surgery combined with traditional rehabilitation group. Pairwise comparisons were made among the groups, and four groups of patients were compared with each other in the postoperative recovery time of intestinal peristalsis, the time of the first postoperative exhaust, postoperative pain score, postoperative activity time, total hospitalization time and C-reactive protein concentration in perioperative periodetc. Results: The postoperative recovery time, postoperative activity time and the total number of days of hospitalization of laparoscopy combined with rapid rehabilitation group patients were significantly shorter than that of the other three groups (P<0.05); postoperative pain score of group A was better than that of the other three groups (P<0.05); CRP of four groups declined in different degrees in the five days, and the blood CRP concentration of combination of laparoscopic fast recovery group was significantly higher than that of the other three groups (P<0.05); There was no significant difference among the four groups in postoperative anal exhaust time (P>0.05). Conclusion: The mode of laparoscopy combined with rapid rehabilitation can shorten patients’ peristalsis recovery time, early activity time of the patient and the total number of days of hospitalization, can relieve pain after surgery. What’s more, certain advantages can be found in patient recovery after surgery, in reducing surgical trauma to the patient’s stress response. It is worthy of promotion for its good clinical benefits.

Key words： rapid recovery laparoscopy colorectal neoplasms clinical application

收稿日期: 2016-09-13

基金资助:温州市科技局科研基金资助项目（Y20120194）

通讯作者: 卢敏，副主任医师，Email：wzlumin@163.com

作者简介: 董殿超（1986-），男，河南信阳人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I6/449

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