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目的探讨胃癌D2根治术围手术期采用快速康复外科(FTS)理念的临床效果。方法选取2013年1月至2015年1月在四川省阆中市人民医院接受胃癌D2根治术治疗的146例患者,按照随机数字表法随机分为观察组和对照组,每组73例。观察组患者采用FTS理念护理,对照组患者用传统康复护理,比较两组患者治疗效果、手术情况、术后并发症。用Logistics回归分析胃癌D2根治术治疗效果的影响因素。结果观察组患者显效率和总有效率分别为46.6%、95.9%,显著高于对照组的28.8%和83.6%,差异均有统计学意义(P<0.05)。观察组患者手术时间、术中出血量、住院时间、术后出现吻合口瘘、感染以及腹胀腹泻等并发症均显著低于对照组,差异均有统计学意义(均P<0.05)。Logistic回归性分析显示,肿瘤大小、组织学分型、有无淋巴结转移、是否应用FTS以及TNM分期等5个影响因素与治疗效果相关。结论胃癌D2根治术围手术期应用FTS,可有效缩短手术时间和术后恢复时间,是否应用FTS是影响胃癌D2根治术的主要因素。FTS具有较高的应用价值,值得临床推广应用。
Objective To investigate the clinical effect of perioperative fast rehabilitative surgery (FTS) on D2 radical mastectomy for gastric cancer. Methods From January 2013 to January 2015, 146 patients with D2 radical mastectomy of gastric cancer in Langzhong People’s Hospital of Sichuan Province were randomly divided into observation group and control group according to random number table method, with 73 cases in each group. Patients in the observation group were treated with FTS concept, and patients in the control group were treated with traditional rehabilitation care. The treatment effect, operation conditions and postoperative complications were compared between the two groups. Influencing Factors of D2 Radical Operation Treatment of Gastric Cancer by Logistics Regression Analysis. Results The effective rate and total effective rate of the observation group were 46.6% and 95.9%, respectively, which were significantly higher than those of the control group (28.8% and 83.6%, P <0.05). The complication of operation time, intraoperative blood loss, length of hospital stay, postoperative anastomotic fistula, infection and abdominal distension and diarrhea in observation group were significantly lower than those in control group (all P <0.05). Logistic regression analysis showed that tumor size, histological type, lymph node metastasis, FTS or TNM staging and other five influencing factors were related to the treatment effect. Conclusion The application of FTS during the perioperative period of D2 radical gastrectomy can shorten the operation time and recovery time effectively. Whether FTS is applied or not is the main factor affecting the radical gastrectomy of gastric cancer. FTS has a high value of application, it is worth clinical promotion and application.