论著 Original Article

快速康复外科及早期肠内营养在胃癌术后患者治疗中的临床价值研究

Published at: 2015年第35卷第4期

乐科发 1 , 赵丽华 2 , 洪和平 1 , 徐辉照 1 , 孙玲花 1 , 孙桥樑 1
1 阳新人民医院 肿瘤科,湖北 阳新 435200
2 阳新人民医院 检验科,湖北 阳新 435200
通讯作者 科发 乐 Email: lekefa@126.com
DOI: 10.3978/j.issn.2095-6959.10.3978/j.issn.2095-6959.2015.04.029
基金:

摘要

目的:观察运用快速康复外科理论(fast track surgery,FTS)及早期肠内营养(early enteral nutrition, EEN)对胃癌术后患者临床指标及免疫功能作用,探讨其促进患者康复的机制及临床价值。 方法:回顾性分析2010年2月~2014年1月我院普外科收治的197例胃癌手术患者资料,其中2012年 6月~2014年1月连续收治的92例采用快速康复外科治疗及早期肠内营养支持(FTS组);2010年 2月~2012年6月连续收治的105例患者按照传统围手术期及常规营养方式处理(传统组),两组行 非随机对照研究,比较两组患者术后首次排气、排便时间,住院时间,各组患者手术前1 d,后第 8天免疫球蛋白(IgA、IgG、IgM),淋巴细胞计数(LYM)和细胞因子CD4+、CD8+、CD4+/CD8+值及 术后并发症的情况。结果:FTS组同传统组相比,患者术后首次排气时间(2.2 vs. 4.9 d)、首次排便时 间(3.4 vs. 5.8 d)明显提前,住院时间(5.2 vs. 8.9 d)显著缩短,差异均具有统计学意义(P<0.05)。FTS组 患者IgA、IgM、CD4+显著升高,LYM和CD4+/CD8+升高,IgG接近术前水平,CD8+降低;FTS组患 者并发症低于传统组,但无统计学差异(P=0.45)。结论:应用快速康复外科理念及早期肠内营养处 理可促进术后肠功能的恢复,提高胃癌术后患者免疫功能,但并不增加术后并发症发生率。


Clinical value of fast track surgery and early enteral nutrition in the treatment of patients with gastric cancer

Abstract

Objective: To observe the effects of fast track surgery theory and early enteral nutrition on clinical indicators and immune function of patients with gastric cancer. To investigate the mechanisms and clinical value of promoting the rehabilitation of patients. Methods: A non-randomized controlled study was undertaken. Data were collected from 197 patients with gastric cancer who were treated from February 2010 to January 2014, including 92 patients having undergone FTS with EEN and 105 patients having undergone conventional perioperative care. Out comes were assessed using the time to first flatus and defecation, the length of postoperative hospital stay and postoperative complications. Furthermore, immunoglobulin and T lymphocyte subsets in blood samples from two group patients were detected. Results: The time to first flatus (2.2 vs. 4.9 d) and defecation (3.4 vs. 5.8 d) and the length of hospital stay (5.2 vs. 8.9 d) in the FTS group were significantly shorter than those in the conventional treatment group (all P<0.05). The level of IgA, IgM, CD4+,LYM and ratio CD4+/CD8+ in the FTS group were significantly higher than those in the conventional treatment group (all P<0.05). The level of CD8+was crosscurrent. The overall incidence of complications in the FTS group was lower than that in the conventional treatment group (28.2% vs. 29.5%), but the difference had no statistical significance (P=0.45). Conclusion: Application of FTS and EEN could promote recovery of bowel function of patients with gastric cancer and improve their immunologic function, however, it would not increase the incidence of postoperative complications.


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引用

引用本文: 科发 乐, 丽华 赵, 和平 洪, 辉照 徐, 玲花 孙, 桥樑 孙. 快速康复外科及早期肠内营养在胃癌术后患者治疗中的临床价值研究[J]. 临床与病理杂志, 2015, 35(4): 671-675.
Cite this article as: LE Kefa, ZHAO Lihua, HONG Heping, XU Huizhao, SUN Linghua, SUN Qiaoliang . Clinical value of fast track surgery and early enteral nutrition in the treatment of patients with gastric cancer[J]. Journal of Clinical and Pathological Research, 2015, 35(4): 671-675.