快速流程圍手術期臨床管理降低結直腸癌手術炎性反應的隨機臨床研究_《中國普外基礎與臨床雜志》

作者：

劉展 ^1,2 , 楊廷翰 ^1,3,4 , 余曦 ^1,3,4 , 李蔚 ^1,3,5 , 汪曉東 ^1,3 , 李立 ^1,3

1.四川大學華西醫院胃腸外科中心（成都 610041）;;
2.成都市第三人民醫院普外科（成都 610031）;;
3.四川大學華西醫院MCQ團隊（成都 610041）;;
4.四川大學華西臨床醫學院（成都 610041）;;
5.四川大學華西口腔醫學院（成都 610041）;

關鍵詞：

結直腸手術快速流程圍手術期臨床管理炎性反應隨機臨床研究

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目的評價在非微創手術條件下快速流程（fasttrack,FT）圍手術期臨床管理對結直腸癌圍手術期炎性反應的影響。方法將55例擇期結直腸癌手術患者隨機分為2組，分別接受FT圍手術期管理（FT組，n=29）和傳統圍手術期管理（傳統組，n=26），均接受常規非微創開腹手術，檢測2組患者術前24 h及術后24 h、72 h和7 d共4個截點的血漿C反應蛋白（CRP）和血漿淀粉樣蛋白（SAA）濃度并作統計學分析。
結果 2組患者均無影響實驗結果的并發癥發生，均無手術死亡。2組內患者的CRP和SAA濃度變化趨勢一致。FT組患者CRP和SAA濃度在術后24 h即達到峰值〔CRP: (72.36±60.94) mg/L; SAA: (328.97±267.20) mg/L〕，傳統組峰值推后，出現于術后72 h 〔CRP: (112.71±63.92) mg/L; SAA: (524.18±331.03) mg/L〕; 術后72 h時FT組CRP 和SAA濃度已經開始下降〔CRP: (57.21±30.42) mg/L; SAA: (237.43±215.66) mg/L〕; FT組CRP及SAA峰值均明顯低于傳統組(P lt;0.001); 術后72 h時FT組CRP和SAA濃度明顯低于傳統組(P lt;0.001)。術后7 d，2組患者CRP和SAA濃度進一步下降，組間比較差異無統計學意義（P gt;0.05）; 且均低于各組內術后24 h 及72 h時的CRP和SAA值（P lt;0.001），但均高于各組內術前24 h的CRP和SAA值（P lt;0.001）。
結論在非微創手術條件下，快速流程圍手術期臨床管理可顯著減輕結直腸癌手術的炎性反應，科學的臨床管理也是促進患者快速康復的重要手段。

引用本文： 劉展 ,楊廷翰,余曦,李蔚,汪曉東,李立. 快速流程圍手術期臨床管理降低結直腸癌手術炎性反應的隨機臨床研究. 中國普外基礎與臨床雜志, 2010, 17(8): 855-859下轉864. doi: 復制

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10.	Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fasttrack surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408412.
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12.	Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466477.
13.	Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [J]. Lancet, 2007; 370(9605): 21122117.
14.	Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
15.	PenaSoria MJ, Mayol JM, Anula R, et al. Singleblinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis [J]. J Gastrointest Surg, 2008; 12(12): 21032109.
16.	Pineda CE, Shelton AA, HernandezBoussard T, et al. Mechanical bowel preparation in intestinal surgery: a metaanalysis and review of the literature [J]. J Gastrointest Surg, 2008;12(11): 20372044.
17.	Cheatham ML, Chapman WC, Key SP, et al. A metaanalysis of selective versus routine nasogastric decompression after elective laparotomy [J]. Ann Surg, 1995; 221(5): 469478.
18.	Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and metaanalysis [J]. Ann Surg, 1999; 229(2): 174180.
19.	Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer [J].Ann Surg, 2007; 245(6): 867872.
20.	Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus [J]. World J Surg, 2006; 30(8): 13821391.
21.	Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operationis it evidencebased? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 4554.
22.	Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery [J]. Proc Nutr Soc, 2003; 62(4): 807811.
23.	Kuzma J. Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioidsparing analgesia versus traditional care after open appendectomy [J]. Clin Nutr, 2008; 27(5): 694699.
24.	HanGuerts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery [J]. Br J Surg, 2007; 94(5): 555561.
25.	Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416423.
26.	King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300308.
27.	Vlug MS, Wind J, van der Zaag E, et al. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme [J]. Colorectal Dis, 2009; 11(4): 335343.

1. 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241.
2. 許劍民, 鐘蕓詩, 朱德祥, 等. 促進術后恢復綜合方案在結直腸癌根治術中的應用 [J]. 中華胃腸外科雜志, 2007; 10(3): 238244.
3. 劉展，汪曉東，李立. 結直腸外科快速流程內容及依據 [J]. 中國普外基礎與臨床雜志, 2007; 14(4): 469473.
4. Kehlet H. Surgical stress response: does endoscopic surgery confer an advantage? [J]. World J Surg, 1999; 23(8): 801807.
5. Nakagoe T, Tsuji T, Sawai T, et al. Minilaparotomy may be independently associated with reduction in inflammatory responses after resection for colorectal cancer [J]. Eur Surg Res, 2003; 35(6): 477485.
6. Wind J, Polle SW, Fung Kon Jin PH, et al. Systematic review of enhanced recovery programmes in colonic surgery [J]. Br J Surg, 2006; 93(7): 800809.
7. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acutephase reactant for clinical practice [J]. Eur J Clin Invest, 1996; 26(6): 427435.
8. Adlouni A, Ghalim N, Sale R, et al. Beneficial effect on serum apo AI, apo B and Lp AI levels of Ramadan fasting [J]. Clin Chim Acta, 1998; 271(2): 179189.
9. Reismann M, von Kampen M, Laupichler B, et al. Fasttrack surgery in infants and children [J]. J Pediatr Surg, 2007; 42(1): 234238.
10. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fasttrack surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408412.
11. Feo CV, Lanzara S, Sortini D, et al. Fast track postoperative management after elective colorectal surgery: a controlled trial [J]. Am Surg, 2009; 75(12): 12471251.
12. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466477.
13. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [J]. Lancet, 2007; 370(9605): 21122117.
14. Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
15. PenaSoria MJ, Mayol JM, Anula R, et al. Singleblinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis [J]. J Gastrointest Surg, 2008; 12(12): 21032109.
16. Pineda CE, Shelton AA, HernandezBoussard T, et al. Mechanical bowel preparation in intestinal surgery: a metaanalysis and review of the literature [J]. J Gastrointest Surg, 2008;12(11): 20372044.
17. Cheatham ML, Chapman WC, Key SP, et al. A metaanalysis of selective versus routine nasogastric decompression after elective laparotomy [J]. Ann Surg, 1995; 221(5): 469478.
18. Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and metaanalysis [J]. Ann Surg, 1999; 229(2): 174180.
19. Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer [J].Ann Surg, 2007; 245(6): 867872.
20. Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus [J]. World J Surg, 2006; 30(8): 13821391.
21. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operationis it evidencebased? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 4554.
22. Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery [J]. Proc Nutr Soc, 2003; 62(4): 807811.
23. Kuzma J. Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioidsparing analgesia versus traditional care after open appendectomy [J]. Clin Nutr, 2008; 27(5): 694699.
24. HanGuerts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery [J]. Br J Surg, 2007; 94(5): 555561.
25. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416423.
26. King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300308.
27. Vlug MS, Wind J, van der Zaag E, et al. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme [J]. Colorectal Dis, 2009; 11(4): 335343.

《中國普外基礎與臨床雜志》

快速流程圍手術期臨床管理降低結直腸癌手術炎性反應的隨機臨床研究

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《中國普外基礎與臨床雜志》

快速流程圍手術期臨床管理降低結直腸癌手術炎性反應的隨機臨床研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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