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目的探讨高龄(≥70岁)结直肠癌患者快速流程(FT)的可行性及应用情况。方法前瞻性纳入2007年11月至2009年1月期间四川大学华西医院胃肠外科中心结直肠外科专业组收治的103例高龄结直肠癌患者,所有患者均完成研究终点观察。随机分为FT组(51例)和传统组(52例),比较2组患者术后早期恢复情况及并发症发生率,并记录了FT组各环节的完成情况。结果①术后早期康复方面,FT组和传统组首次下床时间分别为(1.96±0.89)d和(2.92±1.43)d,首次经口进食时间分别为(2.41±0.92)d和(3.62±1.40)d,首次排气时间分别为(3.88±1.05)d和(4.52±1.29)d,以上指标FT组均明显早于传统组(P<0.05).②术后住院时间方面,FT组和传统组分别为(9.27±1.87)d和(12.75±7.05)d,FT组明显少于传统组(P<0.05).③2组术后2周病死率及再入院率都为0。④术后并发症方面,FT组和传统组总的并发症发生率分别为11.76%(6/51)和28.85%(15/52),FT组明显低于传统组(P<0.05).但2组的一般并发症和手术并发症发生率差异均无统计学意义(P>0.05).⑤在FT组中,所有患者均采用了限制液体策略,而其他主要环节在高龄患者中均未能够全部得以实施。结论高龄结直肠癌患者FT是安全、可行的,能够促进患者早期康复,降低并发症发生率,缩短住院时间,并可能随着FT环节完成度的增加而取得更明显的临床效果。
Objective To investigate the feasibility and application of rapid flow (FT) in elderly patients (≥70 years) with colorectal cancer. Methods A total of 103 elderly patients with colorectal cancer admitted to the Department of Colorectal Surgery, West China Hospital of Sichuan University from November 2007 to January 2009 were prospectively enrolled. All patients completed the study. The patients were randomly divided into FT group (n = 51) and traditional group (n = 52). The early postoperative recovery and the complication rate were compared between two groups. The completion of each group was recorded. Results ① In the early postoperative recovery period, the time to first bed-entry in FT group was (1.96 ± 0.89) d and (2.92 ± 1.43) days respectively, and the first oral feeding time was (2.41 ± 0.92) d and (3.62 ± 1.40) d, and the first time of deflation was (3.88 ± 1.05) d and (4.52 ± 1.29) d, respectively. All of the above indexes were significantly earlier in FT group than in traditional group (P <0.05) The traditional group were (9.27 ± 1.87) d and (12.75 ± 7.05) d, respectively, and the FT group was significantly less than the traditional group (P <0.05) .③The mortality and readmission rates of the 2 groups were all 0 at 2 weeks after operation. ④Complications of postoperative complications, the overall complication rates in FT group and traditional group were 11.76% (6/51) and 28.85% (15/52), respectively, while those in FT group were significantly lower than those in conventional group (P <0.05). There was no significant difference between the two groups in the incidence of general complications and surgical complications (P> 0.05) .5 In the FT group, all patients were limited to fluid strategies and none of the other major components were associated with advanced age All to be implemented. Conclusion The FT in elderly patients with colorectal cancer is safe and feasible. It can promote the early rehabilitation of patients, reduce the incidence of complications and shorten the hospital stay, and may achieve more obvious clinical effects with the completion of FT.