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目的比较腹腔镜手术与应用快速流程(fast track,FT)的开腹手术对结直肠癌患者术后短期康复效果的差异。方法回顾性分析了四川大学华西医院胃肠外科中心结直肠外科专业组2008年2~8月期间收治的177例结直肠癌患者,根据手术方式的不同将患者分为开腹组(122例)和腹腔镜组(55例),开腹组再根据管理方式的不同分为FT组(66例)和传统组(56例),比较3组患者术后短期康复指标的差异。结果①3组患者基线情况比较,除了腹腔镜组的手术时间长于开腹组(P<0.05)外,其余指标比较差异无统计学意义(P>0.05)。②术后康复指标中,FT组〔(3.86±1.01)d〕和腹腔镜组〔(3.78±1.10)d〕的首次排气时间均早于传统组〔(4.43±1.25)d〕,其差异有统计学意义(P<0.05)。③早期经口进食方面,FT组〔(2.52±1.14)d〕早于传统组〔(3.38±1.43)d〕和腹腔镜组〔(5.04±2.24)d〕,其差异有统计学意义(P<0.05);传统组也早于腹腔镜组,其差异有统计学意义(P<0.05)。④对于术后管道(胃管、引流管和尿管)首次拔除时间,FT组和传统组均早于腹腔镜组,差异有统计学意义(P<0.05)。⑤术后住院时间方面,FT组〔(8.33±1.98)d〕明显早于传统组〔(10.82±3.76)d〕和腹腔镜组〔(10.55±3.14)d〕,其差异有统计学意义(P<0.05)。⑥术后并发症方面,3组患者并发症总发生率及各项并发症的发生率之间的差异均无统计学意义(P>0.05)。结论 FT和腹腔镜手术能够促进术后早期结直肠癌患者肠功能恢复,而FT还能缩短术后住院时间,更佳的术后康复方案尚需进一步研究证实。
Objective To compare the short-term effect of postoperative rehabilitation of patients with colorectal cancer after laparoscopic surgery and open-circuit surgery using fast track (FT). Methods A retrospective analysis of 177 patients with colorectal cancer admitted to Department of Colorectal Surgery, Huaxi Hospital, West China Hospital of Sichuan University from February to August in 2008 was divided into open group (122 cases) And laparoscopic group (55 cases). The open group was divided into FT group (66 cases) and traditional group (56 cases) according to different management methods. The differences of short-term rehabilitation indexes between the three groups were compared. Results ① Compared with the laparoscopic group (P <0.05), there was no significant difference in other indexes between the three groups (P> 0.05). (2) In the postoperative rehabilitation indexes, the time of the first deflation in the FT group 〔(3.86 ± 1.01) d〕 and the laparoscopic group 〔(3.78 ± 1.10) d〕 was earlier than that in the traditional group 〔(4.43 ± 1.25) d〕 There was statistical significance (P <0.05). (3) Compared with the traditional group (3.38 ± 1.43) d and the laparoscopic group 〔(5.04 ± 2.24) d〕, the FT group 〔(2.52 ± 1.14) d〕 had earlier statistical significance (P <0.05). The traditional group was also earlier than the laparoscopic group, the difference was statistically significant (P <0.05). ④ For the first time after the operation of the tube (tube, drainage tube and catheter), the FT group and the traditional group were earlier than the laparoscopic group, the difference was statistically significant (P <0.05). ⑤ The postoperative hospital stay, FT group 〔(8.33 ± 1.98) d〕 was significantly earlier than the traditional group (10.82 ± 3.76) d and the laparoscopic group 〔(10.55 ± 3.14) d〕, the difference was statistically significant P <0.05). ⑥ Postoperative complications, the total incidence of complications and the incidence of complications in the three groups were not statistically different (P> 0.05). Conclusion FT and laparoscopic surgery can promote early postoperative recovery of intestinal function in patients with colorectal cancer, while FT can shorten the postoperative hospital stay, and better postoperative rehabilitation program needs further study confirmed.