快速流程模式下術后限制補液對不同手術方案直腸癌患者康復情況的影響_《中國普外基礎與臨床雜志》

作者：

肖凌 ^1,2,3 , 李蔚 ^1,2,3 , 麥玲 ^1,2 , 汪曉東 ¹ , 李立 ¹

1.四川大學華西醫院胃腸外科中心（成都 610041）;;
2.四川大學華西醫院MCQ團隊（成都 610041）;;
3.四川大學華西口腔醫學院（成都 610041）;

關鍵詞：

限制補液手術直腸癌快速流程

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的比較快速流程模式下不同手術方案聯合術后限制補液策略對直腸癌患者術后康復情況的影響。
方法回顧性研究2008年1月至2009年1月期間四川大學華西醫院肛腸外科專業組收治的直腸癌患者的臨床資料，分析比較術后不同補液策略聯合不同手術方案〔高位前切除術（HAR）、低位/超低位前切除術（LAR）〕綜合治療的直腸癌患者術后康復情況。
結果從術后康復指標看，常規補液組的術后排氣、排便、進食及下床活動時間均長于限制補液組（P lt;0.05）；常規補液組中LAR組的術后排氣、排便及進食時間均長于HAR組（P lt;0.05）；限制補液組中LAR組與HAR組其術后早期恢復指標間的差異則無統計學意義(P gt;0.05)。從術后并發癥的發生率上看，常規補液組的肺部感染、傷口感染和腸梗阻發生率均高于限制補液組（P lt;0.05）；常規補液組中LAR和HAR組間的術后并發癥發生率差異無統計學意義（P gt;0.05）；限制補液組中LAR和HAR組間的術后早期恢復和并發癥發生率的差異無統計學意義(P gt;0.05)。
結論不同部位的直腸癌切除術后采取限制補液策略是可行的，能促使患者的早期康復。

引用本文： 肖凌,李蔚,麥玲,汪曉東,李立. 快速流程模式下術后限制補液對不同手術方案直腸癌患者康復情況的影響. 中國普外基礎與臨床雜志, 2010, 17(2): 190-194. doi: 復制

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13.	Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg， 2005; 101(2): 601605.
14.	Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
15.	肖凌，汪曉東，李立. 術后液體管理在結直腸外科快速流程中的應用進展 [J]. 中國普外基礎與臨床雜志, 2009; 16(7): 593596.
16.	Moller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 5762.
17.	MacKay G, Fearon K, McConnachie A, et al . Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 14691474.
18.	Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.
19.	Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
20.	von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
21.	Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
22.	Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg， 2006; 93(9): 10691076.
23.	Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24.	HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med， 1997; 23(3): 276281.
25.	Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.

1. Schwenk W, Haase O, Raue W, et al. Establishing “fasttrack” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129 (6): 502509.
2. 劉展，汪曉東，李立. 多學科協作診治模式下的結直腸外科快速康復流程 [J]. 中國普外基礎與臨床雜志, 2007; 14(2): 239242.
3. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. The danish study group on perioperative fluid therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg， 2003; 238(5): 641648.
5. Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review [J]. Dig Surg, 2008; 25(2)： 148157.
6. 吳在德, 吳肇漢. 外科學 [M]. 第7版. 北京: 人民衛生出版社, 2008： 66.
7. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
8. 李立，汪曉東，舒曄，等. 四川大學華西醫院·結直腸癌手術治療指南(二) [J]. 中國普外基礎與臨床雜志, 2008; 15(11): 861862.
9. 呂東昊，汪曉東，陽川華，等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [J]. 中國普外基礎與臨床雜志, 2007; 14(6): 713716.
10. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3)： 355360.
11. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
12. Gan TJ, Soppitt A, Maroof M, et al. Goaldirected intraoperative fluid administration reduces length of hospital stay after major surgery [J]. Anesthesiology, 2002; 97(4): 820826.
13. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg， 2005; 101(2): 601605.
14. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
15. 肖凌，汪曉東，李立. 術后液體管理在結直腸外科快速流程中的應用進展 [J]. 中國普外基礎與臨床雜志, 2009; 16(7): 593596.
16. Moller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 5762.
17. MacKay G, Fearon K, McConnachie A, et al . Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 14691474.
18. Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.
19. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
20. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
21. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg， 2006; 93(9): 10691076.
23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med， 1997; 23(3): 276281.
25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.

《中國普外基礎與臨床雜志》

快速流程模式下術后限制補液對不同手術方案直腸癌患者康復情況的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國普外基礎與臨床雜志》

快速流程模式下術后限制補液對不同手術方案直腸癌患者康復情況的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料